Cardio-med surg
A nurse providing teaching for a client who is 2 days postoperative following a heart transplant. What statement should the nurse include in the teaching?
"You may no longer be able to feel chest pain." Heart transplant clients usually are no longer able to feel chest pain due to the denervation of the heart.
How long is the PR interval?
0.12 - 0.20 seconds Beginning of P - beginning of QRS
What is the maximum amount of fluid a patient could have in one day who is on fluid restrictions?
2,000 mL/day
What is the maximum amount of sodium a patient could have in one day who is on sodium restrictions?
2,000 mg/day
What is the therapeutic INR range for Coumadin (warfarin)?
2.5 - 3.5
How long is the QRS interval?
< 0.12 seconds Beginning of Q to the end of S
In sinus bradycardia, how fast does the sinus node fire?
<60 BPM This could be a normal rhythm in aerobically trained athletes and during sleep
Which individuals would the nurse identify as having the highest risk for CAD? A 45-year-old depressed male with a high-stress job A 60-year-old male with below normal homocysteine levels A 54-year-old female vegetarian with elevated high-density lipoprotein (HDL) levels A 62-year-old female who has a sedentary lifestyle and body mass index (BMI) of 23 kg/m2
A 45-year-old depressed male with a high-stress job The 45-year-old depressed male with a high-stress job is at the highest risk for CAD. Studies demonstrate that depression and stressful states can contribute to the development of CAD. Elevated HDL levels and low homocysteine levels actually help to prevent CAD. Although a sedentary lifestyle is a risk factor, a BMI of 23 kg/m2 depicts normal weight, and thus the patient with two risk factors is at greatest risk for developing CAD.
A nurse is providing health teaching for a group of clients. Which type of client is at risk for developing peripheral arterial disease?
A client who has diabetes mellitus Diabetes mellitus places the client at risk for microvascular damage and progressive peripheral arterial disease.
What is a Thallium scan?
A nuclear imaging test that shows how well blood flows into the heart during exercise and rest. No smoking or caffeine 4 hours before
What is a holter monitor
A portable device that records the rhythm of the heart continuously, typically for 24-48 hours, by means of electrodes attached to the chest. Teach patient to record daily activities.
What would you teach a patient after receiving a heart transplant?
After transplant, nerves are disrupted and the patient will not feel chest pain. The patient will be on life-long immunosuppressant therapy.
What are the non-modifiable risk factors for CAD?
Age Gender Ethnicity Family history Genetics
What is metoprolol and what should you assess for?
Antidysrhythmic and antihypertensive Hold if HR is less than 60/min
What prevents vasoconstriction that should be given with nitroglycerin?
Aspirin
What are the clinical associations of sinus tachycardia?
Associated with physiologic stressors -Exercise, pain, hypovolemia, hypoxia -Myocardial ischemia, HF -Fever, hyperthyroidism, anxiety, hypoglycemia -Effects of drugs (epinephrine, norepinephrine, atropine, caffeine, pseudoephedrine)
What is the marker of choice in determining whether dyspnea is due to a cardiac or respiratory cause?
B-type natriuretic peptide (BNP)
Where does blood backup into with right sided HF?
Backup of blood into the right atrium and venous systemic circulation
A stable patient with acute decompensated heart failure (ADHF) suddenly becomes dyspneic. Before positioning the patient on the bedside, what should the nurse assess first? Urine output Heart rhythm Breath sounds Blood pressure
Blood pressure The nurse should evaluate the blood pressure before dangling the patient on the bedside because the blood pressure can decrease as blood pools in the periphery and preload decreases. If the patient's blood pressure is low or marginal, the nurse should put the patient in the semi-Fowler's position and use other measures to improve gas exchange.
What are the risk factors for HF?
CAD Advancing age Diabetes HTN Tobacco use COPD Obesity High cholesterol Heredity
What is the cardiac marker that shows up 4-6 hours after an MI, peaks in 24 hours and is no longer evident after 3 days?
CK-MB (creatine kinase heart muscle specific)
Beyond the first year after a heart transplant, the nurse knows that what is a major cause of death? Infection Acute rejection Immunosuppression Cardiac vasculopathy
Cardiac vasculopathy Beyond the first year after a heart transplant, malignancy (especially lymphoma) and cardiac vasculopathy (accelerated CAD) are the major causes of death. During the first year after transplant, infection and acute rejection are the major causes of death. Immunosuppressive therapy will be used for posttransplant management to prevent rejection and increases the patient's risk of an infection.
What do you check for both types of heart block?
Check electrolytes (Mg+, K+, Ca++), Digoxin level
A nurse is assessing a client in the emergency room who has a bradydysrhythmia. Which of the following findings should the nurse expect?
Confusion Bradydysrhythmia can cause decreased tissue perfusion, which can lead to confusion. Therefore, the nurse should monitor the client's mental status.
What is ventricular tachycardia?
Considered life-threatening because of decreased cardiac output and the possibility of deterioration to ventricular fibrillation.
What is variant (Prinzmetal's)?
Coronary artery spasm
How would you calculate heart rate using R-R intervals?
Count the R-R intervals in 6 seconds and multiply by 10
A nurse is caring for a client who had an onset of chest pain 24 hr ago. The nurse should recognize that an increase in what diagnostic is indicative of a myocardial infarction (MI)?
Creatine kinase-MB Creatine kinase-MB is the isoenzyme specific to the myocardium and is elevated when that muscle is injured.
What are the treatment options for a-fib?
Decrease ventricular rate and prevent embolic stroke Long-term anticoagulation - Coumadin Cardioversion - need anticoagulation for 4-6 weeks prior, hold Digoxin for 48 hours before.
What is a fatty streak?
Earliest lesions of atherocsclerosis. Lipid filled muscle cells cause a yellow tinge.
What are the modifiable risk factors for CAD?
Elevated serum lipids (high LDL, triglycerides; low HDL) HTN Tobacco use Physical inactivity Obesity DM Substance abuse
What causes premature atrial contraction?
Emotional stress Use of caffeine, tobacco, alcohol Hypoxia, electrolyte imbalances, COPD, Valvular disease
While doing an admission assessment, the nurse notes clubbing of the patient's fingers. Based on this finding, the nurse will question the patient about which disease process? Endocarditis Acute kidney injury Myocardial infarction Chronic thrombophlebitis
Endocarditis Clubbing of the fingers is a loss of the normal angle between the base of the nail and the skin. This finding can be found in endocarditis, congenital defects, and/or prolonged oxygen deficiency. Clinical manifestations of acute kidney injury, myocardial infarction, and chronic thrombophlebitis will not include clubbing of the fingers.
A patient in asystole is likely to receive which drug treatment? Epinephrine and atropine Lidocaine and amiodarone Digoxin and procainamide β-adrenergic blockers and dopamine
Epinephrine and atropine Normally the patient in asystole cannot be successfully resuscitated. However, administration of epinephrine and atropine may prompt the return of depolarization and ventricular contraction. Lidocaine and amiodarone are used for PVCs. Digoxin and procainamide are used for ventricular rate control. β-adrenergic blockers are used to slow heart rate, and dopamine is used to increase heart rate.
What is a First Degree Heart Block?
Every impulse is conducted to the ventricles, but duration of AV conduction is prolonged (longer than normal PR interval)
What is the best way to treat an HDL level that is higher than 50 or 60?
Exercise
Which drugs decrease cholesterol absorption?
Ezetimibe (Zetia)
What are some S/S of Digoxin toxicity?
Fatigue weakness confusion Visual changes (yellow halos) Loss of appetite
What is a Third Degree Heart Block?
Form of AV dissociation in which no impulses from the atria are conducted to the ventricles (phone line is cut)
What is the definition of heart failure?
Heart is unable to produce an adequate cardiac output to meet metabolic demands
What is restrictive cardiomyopathy?
Heart unable to relax and stretch to accommodate increased volume
What position would you place a patient with HF or pulmonary edema?
High-Fowler's (easier to breath)
What are the S/S of cardiac tamponade?
Hypotension Jugular vein distention Muffled heart sounds Paradoxical pulse (variance of 10 mm Hg or more in systolic BP between expiration and inspiration
What should the nurse recognize as an indication for the use of dopamine (Intropin) in the care of a patient with heart failure? Acute anxiety Hypotension and tachycardia Peripheral edema and weight gain Paroxysmal nocturnal dyspnea (PND)
Hypotension and tachycardia Dopamine is a β-adrenergic agonist whose inotropic action is used for treatment of severe heart failure accompanied by hemodynamic instability. Such a state may be indicated by tachycardia accompanied by hypotension. PND, anxiety, edema, and weight gain are common signs and symptoms of heart failure, but these do not necessarily warrant the use of dopamine.
When would you not give morphine?
If RR is less than 12/min
What is insufficiency?
Improper closure - blood flows backwards. Causes decreased perfusion
What is hypertrophic cardiomyopathy?
Increase in muscle mass and cardiac wall thickness
B-type natriuretic peptide (BNP)
Increased levels associated with worsening heart failure.
What does and ST segment depression and/or T wave inversion indicate on on ECG?
Ischemia - tissue hypoxia that is reversible
Is heart failure a disease or a syndrome?
It's a syndrome
What are the S/S of right sided HF?
Jugular venous distention Hepatomegaly, splenomegaly Vascular congestion of GI tract Peripheral edema Weight gain Nocturnal polyuria (classic symptom)
Where does blood backup into with left sided HF?
Left atrium and pulmonary veins
A nurse is caring for a client who is being treated for heart failure and has prescriptions for digoxin and furosemide. The nurse should plan to monitor for which of the following as an adverse effect of these medications? Shortness of breath Lightheadedness Dry cough Metallic taste
Lightheadedness Furosemide can cause a substantial drop in blood pressure, resulting in lightheadedness.
A nurse is planning a presentation about hypertension for a community women's group. What lifestyle modifications should the nurse include?
Limited alcohol intake Regular exercise program Smoking cessation
What are some things associated with HF?
Long standing HTN CAD MI
What is an example of a drug used for antiplatelet therapy?
Low dose ASA
What are some considerations when treating with Prednisone?
Monitor electrolyte and blood sugar levels Take with food Don't stop taking abruptly
What would you monitor for when treating with Amphotericin B?
Monitor liver and kidney function
What is MONA?
Morphine Oxygen Nitroglycerin Asprin
Why are the mitral and aortic valves (left side) most commonly affected in valvular heart disease?
Most commonly affected due to higher pressure
What are some of the findings involved with valvular heart disease?
Murmur Extra heart sounds Hoarseness Wheezing Crackles Hepatomegaly Tachycardia
What does and ST segment elevation indicate on on ECG?
Myocardial injury
What are the vasodilator drugs that ↓ preload and after load and ↓ myocardial O2 demand?
Nitroglycerin (Nitrostat) Imdur (isosorbide mononitrate)
What is a Second Degree Type Two Heart Block?
No PR interval lengthening but QRS sporadically blocked
What is the treatment for a first degree heart block?
None if asymptomatic. Check electrolyte and Digoxin levels, may need pacemaker.
When it comes to daily weight, when would you notify the provider?
Notify the provider if gains 2 lbs in 24 hours or 5 lbs in one week.
What is the treatment for cardiogenic shock?
Oxygen Meds (same as with pulmonary edema) Continuous monitoring
PQRST Assessment of Angina
P = Precipitating events - what events or activities Q = Quality of pain - what does the pain feel like R = Radiation of pain - Where is the pain located S = Severity of pain - 0-10 scale T = Timing - When did the pain begin (most important)
What is the treatment for cardiac tamponade?
Pericardiocentesis
What is the treatment for pericarditis?
Pericardiocentesis - Monitor ECG for dysrhythmias during procedure
What would you monitor for when treating with Ibuprofen?
Platelet levels (150,000 min), liver and kidney function
Why do we give colace to MI patients?
Prevention of stimulation of the vagal nerve by bearing down or straining
What are the S/S of left sided HF?
Pulmonary edema (pink frothy sputum) ((hallmark sign)) Dyspnea Orthopnea Decreased systemic perfusion Decrease in urine output (best indicator)
What is stable angina?
Relieved by rest and nitroglycerin
What would a nurse do first prior to cardioversion?
Sedate the patient first Ensure patent airway
Which cholesterol-lowering drugs restrict lipoprotein production?
Simvastatin Atorvastatin Niacin Fenofibrate
How are abnormal cardiac rhythms classified?
Site of origin Effect of rate Rhythm of heart
What is the difference between Stable VT and Unstable VT?
Stable = patient has a pulse Unstable = patient has no pulse
What is defibrillation?
Stops all electrical activity, allowing the SA node to take over.
What is dilated cardiomyopathy?
The most common myopathy. Enlargement of the chambers of the heart
A nurse is performing a cardiac assessment on a client. Identify the area the nurse should inspect when evaluating the point of maximal impulse.
The point of maximal impulse is located at the left fifth intercostal space in the midclavicular line.Inspection of this location allows the nurse to assess for pulsations of the apex area of the heart, which is considered the apical pulse or point of maximal impulse.
What may form in the atria as a result of blood stasis related to a-fib?
Thrombi. Embolus may travel to the brain causing a stroke.
What are 80-90% of MI's due to?
Thrombus formation
The nurse is seeing artifact on the telemetry monitor. Which factors could contribute to this artifact? Disabled automaticity Electrodes in the wrong lead Too much hair under the electrodes Stimulation of the vagus nerve fibers
Too much hair under the electrodes Artifact is caused by muscle activity, electrical interference, or insecure leads and electrodes that could be caused by excessive chest wall hair. Disabled automaticity would cause an atrial dysrhythmia. Electrodes in the wrong lead will measure electricity in a different plane of the heart and may have a different wave form than expected. Stimulation of the vagus nerve fibers causes a decrease in heart rate, not artifact.
For which dysrhythmia is defibrillation primarily indicated? Ventricular fibrillation Third-degree AV block Uncontrolled atrial fibrillation Ventricular tachycardia with a pulse
Ventricular fibrillation Defibrillation is always indicated in the treatment of ventricular fibrillation. Drug treatments are normally used in the treatment of uncontrolled atrial fibrillation and for ventricular tachycardia with a pulse (if the patient is stable). Otherwise, synchronized cardioversion is used (as long as the patient has a pulse). Pacemakers are the treatment of choice for third-degree heart block.
A nurse is assessing a client who has left-sided heart failure. Which manifestation should the nurse expect to find?
Weak peripheral pulses Weak peripheral pulses are related to decreased cardiac output resulting from left-sided heart failure.
When do the majority of deaths occur from an MI?
Within 1 hour of onset
How long is the QT interval?
≤ 0.40 seconds Beginning of Q to the end of T
Integrillin (eptifibatide) is a glycoprotein inhibitor that prevents platelet aggregation. What should you assess for when using this drug?
Active bleeding, bruising
What are some of the possible causes of sinus bradycardia?
Carotid sinus massage Hypothermia Valsalva Hypothyroidism Inferior wall MI
What is unstable angina?
Chest pain that is new in onset, occurs at rest or has worsening pattern. Does not respond to nitro Represents an emergency Increases in occurrence and severity
What is synchronized cardioversion?
Delivers a synchronized counter shock on the R wave of the QRS complex. Choice of therapy for A-fib, PSVT, and VT with a pulse.
Serum Lipids
Triglycerides, cholesterol, phosophipids
What are the after-load reducing medications that decrease resistance to contraction?
ACE inhibitors (catopril) ((report dry cough)) Angiotensin II receptor blockers (Cozaar, Losartan) Calcium channel blockers (Cardizem, Procardia)
What are the risk factors involved in valvular heart disease?
Age HTN Rheumatic fever Ineffective endocarditis Congenital defects Marfan syndrome
What would you assess a patient for who is scheduled for a cardiac catheterization?
Allergies to iodine and shellfish
Homocysteine
Amino acid produced during protein catabolism (breakdown)
What is a warning sign of impending acute MI?
Angina pectoris
How do we treat sinus bradycardia?
Atropine (drug of choice) Epinephrine Dopamine Isoproterenol Pacemaker
What is the treatment for Second Degree Type One?
Atropine, transcutaneous pacing
What is cardiac tamponade?
Fluid accumulation in the pericardial sac causes pressure on the heart
A patient was admitted to the emergency department (ED) 24 hours earlier with complaints of chest pain that were subsequently attributed to ST-segment-elevation myocardial infarction (STEMI). What complication of MI should the nurse anticipate? Unstable angina Cardiac tamponade Sudden cardiac death Cardiac dysrhythmias
Cardiac dysrhythmias The most common complication after MI is dysrhythmias, which are present in 80% of patients. Unstable angina is considered a precursor to MI rather than a complication. Cardiac tamponade is a rare event, and sudden cardiac death is defined as an unexpected death from cardiac causes. Cardiac dysfunction in the period following an MI would not be characterized as sudden cardiac death.
A nurse is reviewing the laboratory results of several clients who have peripheral arterial disease. The nurse should plan to provide dietary teaching for the client who has which of the following laboratory values? Cholesterol 180 mg/dL, HDL 70 mg/dL, LDL 90 mg/dL Cholesterol 185 mg/dL, HDL 50 mg/dL, LDL 120 mg/dL Cholesterol 190 mg/dL, HDL 25 mg/dL, LDL 160 mg/dL Cholesterol 195 mg/dL, HDL 55 mg/dL, LDL 125 mg/dL
Cholesterol 190 mg/dL, HDL 25 mg/dL, LDL 160 mg/dL The expected reference range of cholesterol is less than 200 mg/dL, HDL above 40 mg/dL, and LDL less than 100 mg/dL.
Which drugs increase lipoprotein removal?
Cholestryramine Colesnvelam Colestipol
What is the nursing care with pulmonary edema?
High-Fowlers position Frequent VS, ABGs, electrolytes O2 by high-flow REBREATHER mask Restrict fluid intake Hourly urine output Meds to remove fluid, decrease anxiety, and improve cardiac output: Lasix, morphine, nitroglycerin, lanoxin, captopril, lopressor
What is sinus tachycardia?
Discharge rate from the sinus node is increased as a result of vagal inhibition and is >100 BPM
A patient with a diagnosis of heart failure has been started on a nitroglycerin patch by his primary care provider. What should this patient be taught to avoid? High-potassium foods Drugs to treat erectile dysfunction Nonsteroidal antiinflammatory drugs Over-the-counter H2-receptor blockers
Drugs to treat erectile dysfunction The use of erectile drugs concurrent with nitrates creates a risk of severe hypotension and possibly death. High-potassium foods, NSAIDs, and H2-receptor blockers do not pose a risk in combination with nitrates.
What are the findings associated with rheumatic fever?
Fever Joint pain Tachycardia Dyspnea Rash Friction rub Murmur +Blood cultures ↑ WBC, CRP and ESR
What is the treatment for Third Degree Heart Block?
Permanet pacemaker
After having an MI, the nurse notes the patient has jugular venous distention, gained weight, developed peripheral edema, and has a heart rate of 108/minute. What should the nurse suspect is happening? ADHF Chronic HF Left-sided HF Right-sided HF
Right-sided HF An MI is a primary cause of heart failure. The jugular venous distention, weight gain, peripheral edema, and increased heart rate are manifestations of right-sided heart failure.
A nurse is watching a client's ECG monitor and notes that the client's rhythm has changed from a normal sinus rhythm to supraventricular tachycardia. The client is conscious with a heart rate of 200 to 210/min and has a faint radial pulse. The nurse should anticipate assisting with what intervention?
Vagal stimulation Vagal stimulation can help the client's heart return to a normal sinus rhythm temporarily.
What is fibrous plaque?
A progressive change in endothelium of artery wall. Collagen covers the fatty streak. Result is a narrowing of vessel lumen and decreased blood flow.
What is the cardiac marker that shows up 3-5 hours from onset of MI, stays in the system for 14-21 days and provides the best pictures of trends over time?
Troponin 2
What is a heart block?
Impulse conduction is prolonged to the lower parts of the heart.
C-reactive protein (CRP)
Increases with acute inflammation
The community health nurse is planning health promotion teaching targeted at preventing coronary artery disease (CAD). Which ethnic group would the nurse select as the highest priority for this intervention? White male Hispanic male African American male Native American female
White male The incidence of CAD and myocardial infarction (MI) is highest among white, middle-aged men. Hispanic individuals have lower rates of CAD than non-Hispanic whites or African Americans. African Americans have an earlier age of onset and more severe CAD than whites and more than twice the mortality rate of whites of the same age. Native Americans have increased mortality in less than 35-year-olds and have major modifiable risk factors such as diabetes.
The nurse is preparing to administer digoxin to a patient with heart failure. In preparation, laboratory results are reviewed with the following findings: sodium 139 mEq/L, potassium 5.6 mEq/L, chloride 103 mEq/L, and glucose 106 mg/dL. What should the nurse do next? Withhold the daily dose until the following day. Withhold the dose and report the potassium level. Give the digoxin with a salty snack, such as crackers. Give the digoxin with extra fluids to dilute the sodium level.
Withhold the dose and report the potassium level. The normal potassium level is 3.5 to 5.0 mEq/L. The patient is hyperkalemic, which makes the patient more prone to digoxin toxicity. For this reason, the nurse should withhold the dose and report the potassium level. The physician may order the digoxin to be given once the potassium level has been treated and decreases to within normal range.
What is stenosis?
Impedes blood flowing forward - extra work for the heart
A patient experienced sudden cardiac death (SCD) and survived. What should the nurse expect to be used as preventive treatment for the patient? External pacemaker An electrophysiologic study (EPS) Medications to prevent dysrhythmias Implantable cardioverter-defibrillator (ICD)
Implantable cardioverter-defibrillator (ICD) An ICD is the most common approach to preventing recurrence of SCD. An external pacemaker may be used in the hospital but will not be used for the patient living daily life at home. An EPS may be done to determine if a recurrence is likely and determine the most effective medication treatment. Medications to prevent dysrhythmias are used but are not the best prevention of SCD.
What are the treatment options for Paroxysmal Supraventricular Tachycardia?
Vagal maneuvers (try first) - valsalve, coughing Meds: Amiodarone, Adenosine (push fast), Verapamil Cardioversion
What does a pathologic Q wave indicate?
At least half of the thickness of the heart wall is involved
What are the S/S of bacterial endocarditis?
Fever Murmur Flu-like symptoms Petechiae Splinter Hemorrhages +Blood cultures, ↑ WBC, CRP and ESR ** Antibiotic prophylaxis for anyone at risk or with a history of infective endocarditis.
What is the treatment for ventricular fibrillation?
Immediate CPR, Defibrillation ASAP Drugs: Amiodarone, lidocaine, epinephrine.
This cardiac marker is found in both cardiac and skeletal muscles. It rises 2 hours after symptoms but no longer present after 24 hours. It comes into play much sooner than other markers and is an early indicator of heart injury. What is it?
Myoglobin
What is a Second Degree Type One Heart Block?
PR interval increases until QRS is blocked
For which problem is percutaneous coronary intervention (PCI) most clearly indicated? Chronic stable angina Left-sided heart failure Coronary artery disease Acute myocardial infarction
Acute myocardial infarction PCI is indicated to restore coronary perfusion in cases of myocardial infarction. Chronic stable angina and CAD are normally treated with more conservative measures initially. PCI is not relevant to the pathophysiology of heart failure, such as left-sided heart failure.
Angina vs. MI
Angina: Precipitated by exertion or stress Relieved by rest or nitroglycerin S/S last less than 15 min No nausea, epigastric pain, dyspnea, anxiety or diaphoresis MI: Can occur without cause, often in the morning after rest Relieved only by opioids S/S last more than 30 min Associated with nausea, epigastric pain, dyspnea, anxiety and diaphoresis
A nurse is caring for a client in the first hour following an aortic aneurysm repair. What findings can indicate shock and should be reported to the provider?
Urine output of 20 mL/hr Urine output less than 30 mL/hr can indicate shock because it reflects decreased blood flow to the kidneys, possibly from graft rupture and hemorrhage.
What are the goals of drug therapy for HF?
Identification of type of HF and causes Correction of sodium and water retention and volume overload Reduction of cardiac workload Improvement of myocardial contractility Control of precipitating and complicating factors
What is the primary complication of a heart transplant?
Infection followed by acute rejection in the first year after transplantation
What decreases the incidences of myocarditis?
Influenza and pneumococcal vaccines
What are the inotropic agents that increase contractility and increase cardiac output?
Lanolin (Digoxin) Dopamine, Dobutamine, Milrinone
What is the duration of anticoagulation therapy following a mechanical valve replacement?
Life-long
What are the diuretic medications that decrease preload?
Loop: Lasix (furosemide), bumetanide Thiazide: Hydrocholorthiazide Aldactone (spironolactate)
What are the β-blocker medications that block the action of SNS resulting in ↓ force of contraction, ↓ HR and ↓ BP
Lopressor (metoprolol) Coreg (carvedilol)
In heart disease, would PVCs increase or decrease cardiac output?
PVCs may decrease cardiac output and precipitate angina and HF
What are the symptoms of an MI?
Pain Cardiovascular manifestations Nausea and vomiting Diaphoresis Epigastric pain Dyspnea Fever (due to inflammatory process)
What are the clinical manifestations of pulmonary edema?
Persistent cough with pink, frothy sputum Tachypnea, dyspnea, orthopnea, crackles, hypoxemia, confusion, anxiety, tachycardia and decreased urine output.
How does one take nitroglycerin when experiencing angina?
Place tablet sublingual at first sign of chest pain Repeat dose in 5 min and call 911 if pain is not resolved Can take up to 2 more doses at 5 min intervals
What are Premature Ventricular Contractions?
Premature occurrence of a wide and distorted QRS complex (hallmark sign)
What would you monitor for when treating with Penicillin?
Rash, hives Electrolyte levels and kidney function
Describe the patient education needed for pacemakers
Record daily pulse rate Wear medic alert bracelet Avoid MRI scanners Don't raise arm on side of pacemaker above shoulder for 1-2 weeks Intractable hiccups indicate displaced lead
What is a treatment option for premature atrial contraction?
Reduce or eliminate caffeine
What is ventricular fibrillation?
Severe derangement of the heart rhythm characterized on ECG by irregular undulations of varying contour and amplitude. No effective contraction or cardiac output occurs: Lethal dysrhythmia. Ventricle is quivering.
How fast does the sinus node fire during normal sinus rhythm?
Sinus node fires 60-100 BPM
What is the leading cause of rheumatic fever?
Strep - appears 2-3 weeks after infection
What causes bacterial endocarditis?
Strep or Staph Most common in IV drug users
What are the S/S of cardiogenic shock?
Tachycardia Hypotension ↓ urine output ↓ LOC Respiratory distress ↓ peripheral pulses Chest pain Cool, clammy skin ↑ RR
What are some considerations regarding administration of Digoxin?
Take apical pulse for one minute before giving med. If <60/min hold and call the HO Don't take with antacids (separate by 2 hours)
What is asystole?
Total absence of ventricular electrical activity. Prognosis is extremely poor. Non-shockable.
What is Atrial Fibrillation?
Total disorganization of atrial electrical activity Most common dysrhythmia
What is the treatment for Second Degree Type Two?
Transcutaneous pacing or pacemaker Can quickly lead to Third degree heart block
What is the cardiac marker that shows up 3 hours from onset of MI and stays in system 7-10 days?
Troponin 1
What treatment option would you use first when treating sinus tachycardia?
Vagal maneuvers (hold breath and bear down)
What is Wolff-Parkinson-White Syndrome?
There is extra conduction or accessory pathways - impulse doesn't travel the normal pathway - makes the patient faint
When would you give Streptokinase and Activase?
They are clot busters, give within 6 hours of infarction. Monitor LOC
Postoperative care of a patient undergoing coronary artery bypass graft (CABG) surgery includes monitoring for what common complication? Dehydration Paralytic ileus Atrial dysrhythmias Acute respiratory distress syndrome
Atrial dysrhythmias Postoperative dysrhythmias, specifically atrial dysrhythmias, are common in the first 3 days following CABG surgery. Although the other complications could occur, they are not common complications.
After teaching a patient with chronic stable angina about nitroglycerin, the nurse recognizes the need for further teaching when the patient makes which statement? "I will replace my nitroglycerin supply every 6 months." "I can take up to five tablets every 3 minutes for relief of my chest pain." "I will take acetaminophen (Tylenol) to treat the headache caused by nitroglycerin." "I will take the nitroglycerin 10 minutes before planned activity that usually causes chest pain."
"I can take up to five tablets every 3 minutes for relief of my chest pain." The recommended dose of nitroglycerin is one tablet taken sublingually (SL) or one metered spray for symptoms of angina. If symptoms are unchanged or worse after 5 minutes, the patient should be instructed to activate the emergency medical services (EMS) system. If symptoms are improved, repeat the nitroglycerin every 5 minutes for a maximum of three doses and contact EMS if symptoms have not resolved completely.
The nurse is doing discharge teaching with the patient and spouse of the patient who just received an implantable cardioverter-defibrillator (ICD) in the left side. Which statement by the patient indicates to the nurse that the patient needs more teaching? "I will call the cardiologist if my ICD fires." "I cannot fly because it will damage the ICD." "I cannot move my left arm until it is approved." "I cannot drive until my cardiologist says it is okay."
"I cannot fly because it will damage the ICD." The patient statement that flying will damage the ICD indicates misunderstanding about flying. The patient should be taught that informing TSA about the ICD can be done because it may set off the metal detector and if a hand-held screening wand is used, it should not be placed directly over the ICD. The other options indicate the patient understands the teaching.
A nurse is caring for a client who has a history of angina and is scheduled for a stress test at 1100. What statement by the client requires the nurse to contact the provider for possible rescheduling?
"I smoked a cigarette this morning to calm my nerves about having this procedure." Smoking prior to the test can change the outcome and places the client at additional risk, so the test should be rescheduled.
A nurse is caring for a client who is scheduled for a coronary artery bypass graft (CABG) in 2 hr. Which of the following client statements indicates a need for further clarification by the nurse? "My arthritis is really bothering me because I haven't taken my aspirin in a week." "My blood pressure shouldn't be high because I took my blood pressure medication this morning." "I took my warfarin last night according to my usual schedule." "I will check my blood sugar because I took a reduced dose of insulin this morning."
"I took my warfarin last night according to my usual schedule." Clients scheduled for a CABG should not take anticoagulants, such as warfarin, for 5 to 7 days prior to the surgery to prevent excessive bleeding.
In caring for the patient with angina, the patient said, "I walked to the bathroom. While I was having a bowel movement, I started having the worst chest pain ever, like before I was admitted. I called for a nurse, but the pain is gone now." What further assessment data should the nurse obtain from the patient? "What precipitated the pain?" "Has the pain changed this time?" "In what areas did you feel this pain?" "Rate the pain on a scale from 0 to 10, with 0 being no pain and 10 being the worst pain you can imagine."
"In what areas did you feel this pain?" Using PQRST, the assessment data not volunteered by the patient is the radiation of pain, the area the patient felt the pain, and if it radiated. The precipitating event was going to the bathroom and having a bowel movement. The quality of the pain was "like before I was admitted," although a more specific description may be helpful. Severity of the pain was the "worst chest pain ever," although an actual number may be needed. Timing is supplied by the patient describing when the pain occurred and that he had previously had this pain.
A 25-year-old patient with a group A streptococcal pharyngitis does not want to take the antibiotics prescribed. What should the nurse tell the patient to encourage the patient to take the medications and avoid complications of the infection? "The complications of this infection will affect the skin, hair, and balance." "You will not feel well if you do not take the medicine and get over this infection." "Without treatment, you could get rheumatic fever, which can lead to rheumatic heart disease." "You may not want to take the antibiotics for this infection, but you will be sorry if you do not."
"Without treatment, you could get rheumatic fever, which can lead to rheumatic heart disease." Rheumatic fever (RF) is not common because of effective use of antibiotics to treat streptococcal infections. Without treatment, RF can occur and lead to rheumatic heart disease, especially in young adults. The complications do not include hair or balance. Saying that the patient will not feel well or that the patient will be sorry if the antibiotics are not taken is threatening to the patient and inappropriate for the nurse to say.
When computing a heart rate from the ECG tracing, the nurse counts 15 of the small blocks between the R waves of a patient whose rhythm is regular. From these data, the nurse calculates the patient's heart rate to be 60 beats/min. 75 beats/min. 100 beats/min. 150 beats/min.
100 beats/min Since each small block on the ECG paper represents 0.04 seconds, 1500 of these blocks represents 1 minute. By dividing the number of small blocks (15, in this case) into 1500, the nurse can calculate the heart rate in a patient whose rhythm is regular (in this case, 100).
The patient comes to the ED with severe, prolonged angina that is not immediately reversible. The nurse knows that if the patient once had angina related to a stable atherosclerotic plaque and the plaque ruptures, there may be occlusion of a coronary vessel and this type of pain. How will the nurse document this situation related to pathophysiology, presentation, diagnosis, prognosis, and interventions for this disorder? Unstable angina Acute coronary syndrome (ACS) ST-segment-elevation myocardial infarction (STEMI) Non-ST-segment-elevation myocardial infarction (NSTEMI)
Acute coronary syndrome (ACS) The pain with ACS is severe, prolonged, and not easy to relieve. ACS is associated with deterioration of a once-stable atherosclerotic plaque that ruptures, exposes the intima to blood, and stimulates platelet aggregation and local vasoconstriction with thrombus formation. The unstable lesion, if partially occlusive, will be manifest as unstable angina or NSTEMI. If there is total occlusion, it is manifest as a STEMI.
The patient is being dismissed from the hospital after ACS and will be attending rehabilitation. What information does the patient need to be taught about the early recovery phase of rehabilitation? Therapeutic lifestyle changes should become lifelong habits. Physical activity is always started in the hospital and continued at home. Attention will focus on management of chest pain, anxiety, dysrhythmias, and other complications. Activity level is gradually increased under cardiac rehabilitation team supervision and with ECG monitoring.
Activity level is gradually increased under cardiac rehabilitation team supervision and with ECG monitoring.
A patient admitted with heart failure appears very anxious and complains of shortness of breath. Which nursing actions would be appropriate to alleviate this patient's anxiety (select all that apply)? Administer ordered morphine sulfate. Position patient in a semi-Fowler's position. Position patient on left side with head of bed flat. Instruct patient on the use of relaxation techniques. Use a calm, reassuring approach while talking to patient.
Administer ordered morphine sulfate. Position patient in a semi-Fowler's position. Instruct patient on the use of relaxation techniques. Use a calm, reassuring approach while talking to patient. Morphine sulfate reduces anxiety and may assist in reducing dyspnea. The patient should be positioned in semi-Fowler's position to improve ventilation that will reduce anxiety. Relaxation techniques and a calm reassuring approach will also serve to reduce anxiety.
The nurse is administering a dose of digoxin (Lanoxin) to a patient with heart failure (HF). The nurse would become concerned with the possibility of digitalis toxicity if the patient reported which symptom(s)? Muscle aches Constipation Pounding headache Anorexia and nausea
Anorexia and nausea Anorexia, nausea, vomiting, blurred or yellow vision, and cardiac dysrhythmias are all signs of digitalis toxicity. The nurse would become concerned and notify the health care provider if the patient exhibited any of these symptoms.
The patient had a history of rheumatic fever and has been diagnosed with mitral valve stenosis. The patient is planning to have a biologic valve replacement. What protective mechanisms should the nurse teach the patient about using after the valve replacement? Long-term anticoagulation therapy Antibiotic prophylaxis for dental care Exercise plan to increase cardiac tolerance Take β-adrenergic blockers to control palpitations.
Antibiotic prophylaxis for dental care The patient will need to use antibiotic prophylaxis for dental care to prevent endocarditis. Long-term anticoagulation therapy is not used with biologic valve replacement unless the patient has atrial fibrillation. An exercise plan to increase cardiac tolerance is needed for a patient with heart failure. Taking β-adrenergic blockers to control palpitations is prescribed for mitral valve prolapse, not valve replacement.
The nurse would assess a patient with complaints of chest pain for which clinical manifestations associated with a myocardial infarction (MI) (select all that apply)? Flushing Ashen skin Diaphoresis Nausea and vomiting S3 or S4 heart sounds
Ashen skin Diaphoresis Nausea and vomiting S3 or S4 heart sounds During the initial phase of an MI, catecholamines are released from the ischemic myocardial cells, causing increased sympathetic nervous system (SNS) stimulation. This results in the release of glycogen, diaphoresis, and vasoconstriction of peripheral blood vessels. The patient's skin may be ashen, cool, and clammy (not flushed) as a result of this response. Nausea and vomiting may result from reflex stimulation of the vomiting center by severe pain. Ventricular dysfunction resulting from the MI may lead to the presence of the abnormal S3 and S4 heart sounds.
The nurse is caring for a patient who is 24 hours postpacemaker insertion. Which nursing intervention is most appropriate at this time? Reinforcing the pressure dressing as needed Encouraging range-of-motion exercises of the involved arm Assessing the incision for any redness, swelling, or discharge Applying wet-to-dry dressings every 4 hours to the insertion site
Assessing the incision for any redness, swelling, or discharge After pacemaker insertion, it is important for the nurse to observe signs of infection by assessing for any redness, swelling, or discharge from the incision site. The nonpressure dressing is kept dry until removed, usually 24 hours postoperatively. It is important for the patient to limit activity of the involved arm to minimize pacemaker lead displacement.
A nurse in the emergency department is caring for a client who had an anterior myocardial infarction. The client's history reveals she is 1 week postoperative open cholecystectomy. The nurse should recognize that what intervention is contraindicated?
Assisting with thrombolytic therapy The nurse should recognize that major surgery within the previous 3 weeks is a contraindication for thrombolytic therapy.
The nurse is watching the cardiac monitor, and a patient's rhythm suddenly changes. There are no P waves. Instead there are fine, wavy lines between the QRS complexes. The QRS complexes measure 0.08 sec (narrow), but they occur irregularly with a rate of 120 beats/min. The nurse correctly interprets this rhythm as what? Sinus tachycardia Atrial fibrillation Ventricular fibrillation Ventricular tachycardia
Atrial fibrlillation Atrial fibrillation is represented on the cardiac monitor by irregular R-R intervals and small fibrillatory (f) waves. There are no normal P waves because the atria are not truly contracting, just fibrillating. Sinus tachycardia is a sinus rate above 100 beats/minute with normal P waves. Ventricular fibrillation is seen on the ECG without a visible P wave; an unmeasurable heart rate, PR or QRS; and the rhythm is irregular and chaotic. Ventricular tachycardia is seen as three or more premature ventricular contractions (PVCs) that have distorted QRS complexes with regular or irregular rhythm, and the P wave is usually buried in the QRS complex without a measurable PR interval.
What is the priority assessment by the nurse caring for a patient receiving IV nesiritide (Natrecor) to treat heart failure? Urine output Lung sounds Blood pressure Respiratory rate
Blood pressure Although all identified assessments are appropriate for a patient receiving IV nesiritide, the priority assessment would be monitoring for hypotension, the main adverse effect of nesiritide.
A nurse is caring for a client in the first 8 hr following coronary artery bypass graft (CABG) surgery. What finding should the nurse report to the provider?
Blood pressure 160/80 mm Hg The nurse should report an elevated blood pressure following a CABG procedure because increased vascular pressure can cause bleeding at the incision sites.
The patient is admitted with acute coronary syndrome (ACS). The ECG shows ST-segment depression and T-wave inversion. What should the nurse know that this indicates? Myocardia injury Myocardial ischemia Myocardial infarction A pacemaker is present.
Myocardial ischemia The ST depression and T wave inversion on the ECG of a patient diagnosed with ACS indicate myocardial ischemia from inadequate supply of blood and oxygen to the heart. Myocardial injury is identified with ST-segment elevation. Myocardial infarction is identified with ST-segment elevation and a widened and deep Q wave. A pacemaker's presence is evident on the ECG by a spike leading to depolarization and contraction.
When evaluating a patient's knowledge regarding a low-sodium, low-fat cardiac diet, the nurse recognizes additional teaching is needed when the patient selects which food choice? Baked flounder Angel food cake Baked potato with margarine Canned chicken noodle soup
Canned chicken noodle soup Canned soups are very high in sodium content. Patients need to be taught to read food labels for sodium and fat content.
A male patient with a long-standing history of heart failure has recently qualified for hospice care. What measure should the nurse now prioritize when providing care for this patient? Taper the patient off his current medications. Continue education for the patient and his family. Pursue experimental therapies or surgical options. Choose interventions to promote comfort and prevent suffering.
Choose interventions to promote comfort and prevent suffering. The central focus of hospice care is the promotion of comfort and the prevention of suffering. Patient education should continue, but providing comfort is paramount. Medications should be continued unless they are not tolerated. Experimental therapies and surgeries are not commonly used in the care of hospice patients.
The patient with pericarditis is complaining of chest pain. After assessment, which intervention should the nurse expect to implement to provide pain relief? Corticosteroids Morphine sulfate Proton pump inhibitor Nonsteroidal antiinflammatory drugs
Nonsteroidal antiinflammatory drugs Nonsteroidal antiinflammatory drugs (NSAIDs) will control pain and inflammation. Corticosteroids are reserved for patients already taking corticosteroids for autoimmune conditions or those who do not respond to NSAIDs. Morphine is not necessary. Proton pump inhibitors are used to decrease stomach acid to avoid the risk of GI bleeding from the NSAIDs.
The patient had myocarditis and is now experiencing fatigue, weakness, palpitations, and dyspnea at rest. The nurse assesses pulmonary crackles, edema, and weak peripheral pulses. Sinoatrial tachycardia is evident on the cardiac monitor. The Doppler echocardiography shows dilated cardiomyopathy. What collaborative and nursing care of this patient should be done to improve cardiac output and the quality of life? (Select all that apply.) Decrease preload and afterload. Relieve left ventricular outflow obstruction. Control heart failure by enhancing myocardial contractility. Improve diastolic filling and the underlying disease process. Improve ventricular filling by reducing ventricular contractility.
Decrease preload and after load. Control heart failure by enhancing myocardial contractility. The patient is experiencing dilated cardiomyopathy. To improve cardiac output and quality of life, drug, nutrition, and cardiac rehabilitation will be focused on controlling heart failure by decreasing preload and afterload and improving cardiac output, which will improve the quality of life. Relief of left ventricular outflow obstruction and improving ventricular filling by reducing ventricular contractility is done for hypertrophic cardiomyopathy. There are no specific treatments for restrictive cardiomyopathy, but interventions are aimed at improving diastolic filling and the underlying disease process.
The nurse is providing teaching to a patient recovering from an MI. How should resumption of sexual activity be discussed? Delegated to the primary care provider Discussed along with other physical activities Avoided because it is embarrassing to the patient Accomplished by providing the patient with written material
Discussed along with other physical activities Although some nurses may not feel comfortable discussing sexual activity with patients, it is a necessary component of patient teaching. It is helpful to consider sex as a physical activity and to discuss or explore feelings in this area when other physical activities are discussed. Although providing the patient with written material is appropriate, it should not replace a verbal dialogue that can address the individual patient's questions and concerns.
Which antilipemic medications should the nurse question for a patient with cirrhosis of the liver (select all that apply)? Niacin (Nicobid) Ezetimibe (Zetia) Gemfibrozil (Lopid) Atorvastatin (Lipitor) Cholestyramine (Questran)
Ezetimibe (Zetia) Atorvastatin (Lipitor) Ezetimibe (Zetia) should not be used by patients with liver impairment. Adverse effects of atorvastatin (Lipitor), a statin drug, include liver damage and myopathy. Liver enzymes must be monitored frequently and the medication stopped if these enzymes increase. Niacin's side effects subside with time, although decreased liver function may occur with high doses. Cholestyramine is safe for long-term use.
The patient has hypokalemia, and the nurse obtains the following measurements on the rhythm strip: Heart rate of 86 with a regular rhythm; the P wave is 0.06 seconds (sec) and normal shape; the PR interval is 0.24 sec; the QRS is 0.09 sec. How should the nurse document this rhythm? First-degree AV block Second-degree AV block Premature atrial contraction (PAC) Premature ventricular contraction (PVC)
First-degree AV block In first-degree AV block there is prolonged duration of AV conduction that lengthens the PR interval above 0.20 sec. In type I second-degree AV block the PR interval continues to increase in duration until a QRS complex is blocked. In Type II the PR interval may be normal or prolonged, the ventricular rhythm may be irregular, and the QRS is usually greater than 0.12 sec. PACs cause an irregular rhythm with a different-shaped P wave than the rest of the beats, and the PR interval may be shorter or longer. PVCs cause an irregular rhythm, and the QRS complex is wide and distorted in shape.
A nurse is caring for a client following insertion of a permanent pacemaker. What is a possible complication of the insertion procedure?
I can't get rid of these hiccups." Hiccups can indicate that the pacemaker is stimulating the chest wall or diaphragm, which can indicate a complication such as lead wire perforation.
A nurse is admitting a client who has a leg ulcer and a history of diabetes mellitus. The nurse should use which focused assessments to help differentiate between an arterial ulcer and a venous stasis ulcer?
Inquire about the presence or absence of claudication. Knowing if the client is experiencing claudication helps differentiate venous from arterial ulcers. Clients who have arterial ulcers experience claudication, but those who have venous ulcers do not.
The nurse assesses the right femoral artery puncture site as soon as the patient arrives after having a stent inserted into a coronary artery. The insertion site is not bleeding or discolored. What should the nurse do next to ensure the femoral artery is intact? Palpate the insertion site for induration. Assess peripheral pulses in the right leg. Inspect the patient's right side and back. Compare the color of the left and right legs.
Inspect the patient's right side and back. The best method to determine that the right femoral artery is intact after inspection of the insertion site is to logroll the patient to inspect the right side and back for retroperitoneal bleeding. The artery can be leaking and blood is drawn into the tissues by gravity. The peripheral pulses, color, and sensation of the right leg will be assessed per agency protocol.
A female patient who has type 1 diabetes mellitus has chronic stable angina that is controlled with rest. She states that over the past few months she has required increasing amounts of insulin. What goal should the nurse use to plan care that should help prevent cardiovascular disease progression? Exercise almost every day. Avoid saturated fat intake. Limit calories to daily limit. Keep Hgb A1C less than 7%.
Keep Hgb A1C less than 7%. If the Hgb A1C is kept below 7%, this means that the patient has had good control of her blood glucose over the past 3 months. The patient indicates that increasing amounts of insulin are being required to control her blood glucose. This patient may not be adhering to the dietary guidelines or therapeutic regimen, so teaching about how to maintain diet, exercise, and medications to maintain stable blood glucose levels will be needed to achieve this goal.
A nurse is caring for a client who has dilated cardiomyopathy. The client reports increasing difficulty completing her daily 1-mile walks. The nurse should recognize that this is a finding of which of the following? Left ventricular failure Peripheral vasodilation Pericardial effusion Decreased vascular volume
Left ventricular failure Activity intolerance is a finding of left ventricular failure and is associated with dilated cardiomyopathy.
The patient has heart failure (HF) with an ejection fraction of less than 40%. What core measures should the nurse expect to include in the plan of care for this patient (select all that apply)? Left ventricular function is documented. Controlling dysrhythmias will eliminate HF. Prescription for digoxin (Lanoxin) at discharge Prescription for angiotensin-converting enzyme (ACE) inhibitor at discharge Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen
Left ventricular function is documented. Prescription for angiotensin-converting enzyme (ACE) inhibitor at discharge Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen The Joint Commission has identified these three core measures for heart failure patients. Although controlling dysrhythmias will improve CO and workload, it will not eliminate HF. Prescribing digoxin for all HF patients is no longer done because there are newer effective drugs and digoxin toxicity occurs easily related to electrolyte levels and the therapeutic range must be maintained.
When caring for a patient with infective endocarditis, the nurse will assess the patient for which vascular manifestations (select all that apply)? Osler's nodes Janeway's lesions Splinter hemorrhages Subcutaneous nodules Erythema marginatum lesions
Osler's nodes Janeway's lesions Splinter hemorrhages Osler's nodes, Janeway's lesions, and splinter hemorrhages are all vascular manifestations of infective endocarditis. Subcutaneous nodules and erythema marginatum lesions occur with rheumatic fever.
When planning emergent care for a patient with a suspected MI, what should the nurse anticipate administrating? Oxygen, nitroglycerin, aspirin, and morphine Oxygen, furosemide (Lasix), nitroglycerin, and meperidine Aspirin, nitroprusside (Nipride), dopamine (Intropin), and oxygen Nitroglycerin, lorazepam (Ativan), oxygen, and warfarin (Coumadin)
Oxygen, nitroglycerin, aspirin, and morphine The American Heart Association's guidelines for emergency care of the patient with chest pain include the administration of oxygen, nitroglycerin, aspirin, and morphine. These interventions serve to relieve chest pain, improve oxygenation, decrease myocardial workload, and prevent further platelet aggregation. The other medications may be used later in the patient's treatment.
The nurse is examining the ECG of a patient who has just been admitted with a suspected MI. Which ECG change is most indicative of prolonged or complete coronary occlusion? Sinus tachycardia Pathologic Q wave Fibrillatory P waves Prolonged PR interval
Pathologic Q wave The presence of a pathologic Q wave, as often accompanies STEMI, is indicative of complete coronary occlusion. Sinus tachycardia, fibrillatory P waves (e.g., atrial fibrillation), or a prolonged PR interval (first-degree heart block) are not direct indicators of extensive occlusion.
An 80-year-old patient with uncontrolled type 1 diabetes mellitus is diagnosed with aortic stenosis. When conservative therapy is no longer effective, the nurse knows that the patient will need to do or have what done? Aortic valve replacement Take nitroglycerin for chest pain. Open commissurotomy (valvulotomy) procedure Percutaneous transluminal balloon valvuloplasty (PTBV) procedure
Percutaneous transluminal balloon valvuloplasty (PTBV) procedure The percutaneous transluminal balloon valvuloplasty (PTBV) procedure is best for this older adult patient who is a poor surgery candidate related to the uncontrolled type 1 diabetes mellitus. Aortic valve replacement would probably not be tolerated well by this patient, although it may be done if the PTBV fails and the diabetes is controlled in the future. Nitroglycerin is used cautiously for chest pain because it can reduce BP and worsen chest pain in patients with aortic stenosis. Open commissurotomy procedure is used for mitral stenosis.
A client who has a new diagnosis of hypertension has a prescription for an ACE inhibitor. The nurse instructs the client about adverse effects of the medication. The client demonstrates an understanding of the teaching by stating that he will notify his provider if he experiences what?
Persistent cough A persistent cough is an adverse effect of ACE inhibitors, and the client should discontinue the medication if it occurs.
A nurse is caring for a client who presents to the emergency department with a blood pressure of 254/139 mm Hg. The nurse recognizes that the client is in a hypertensive crisis. Which of the following actions should the nurse take first? Obtain blood samples for laboratory testing. Tell the client to report vision changes. Place the head of the bed at 45°. Initiate an IV.
Place the head of the bed at 45°. The first action the nurse should take when using the airway, breathing, circulation approach to client care is to place the head of the client's bed at 45°. This improves respiratory status and promotes venous return to reduce workload on the heart.
A nurse is providing discharge teaching for a client who has a prescription for the transdermal nitroglycerin patch. What instructions should the nurse include in the teaching?
Place the patch on an area of skin away from skin folds and joints. The client should apply the patch to an area of skin that is not prone to movement or wrinkling.
What is a complicated lesion?
Platelets accumulate in large numbers, leading to a thrombus.
A patient has sought care following a syncopal episode of unknown etiology. Which nursing action should the nurse prioritize in the patient's subsequent diagnostic workup? Preparing to assist with a head-up tilt-test Preparing an IV dose of a β-adrenergic blocker Assessing the patient's knowledge of pacemakers Teaching the patient about the role of antiplatelet aggregators
Preparing to assist with a head-up tilt-test In patients without structural heart disease, the head-up tilt-test is a common component of the diagnostic workup following episodes of syncope. IV β-blockers are not indicated although an IV infusion of low-dose isoproterenol may be started in an attempt to provoke a response if the head-up tilt-test did not have a response. Addressing pacemakers is premature and inappropriate at this stage of diagnosis. Patient teaching surrounding antiplatelet aggregators is not directly relevant to the patient's syncope at this time.
A nurse is preparing a client for coronary angiography. The nurse should report what finding to the provider prior to the procedure?
Previous allergic reaction to shellfish The contrast medium used is iodine-based. Clients who have a history of allergic reaction to shellfish often react to iodine and might need a steroid or antihistamine.
A nurse is caring for a client following an abdominal aortic aneurysm resection. What is the priority assessment for this client?
Urine output The greatest risk to this client is graft occlusion or rupture. Therefore, monitoring urine output, which reflects blood flow to the kidneys, is the priority assessment.
While admitting a patient with pericarditis, the nurse will assess for what manifestations of this disorder? Pulsus paradoxus Prolonged PR intervals Widened pulse pressure Clubbing of the fingers
Pulslus paradoxus Pericarditis can lead to cardiac tamponade, an emergency situation. Pulsus paradoxus greater than 10 mm Hg is a sign of cardiac tamponade that should be assessed at least every 4 hours in a patient with pericarditis. Prolonged PR intervals occur with first-degree AV block. Widened pulse pressure occurs with valvular heart disease. Clubbing of fingers may occur in subacute forms of infective endocarditis and valvular heart disease.
Which ECG characteristic is consistent with a diagnosis of ventricular tachycardia (VT)? Unmeasurable rate and rhythm Rate 150 beats/min; inverted P wave Rate 200 beats/min; P wave not visible Rate 125 beats/min; normal QRS complex
Rate 200 beats/min; P wave not visible VT is associated with a rate of 150 to 250 beats/min; the P wave is not normally visible. Rate and rhythm are not measurable in ventricular fibrillation. P wave inversion and a normal QRS complex are not associated with VT.
A patient with a recent diagnosis of heart failure has been prescribed furosemide (Lasix) in an effort to physiologically do what for the patient? Reduce preload. Decrease afterload. Increase contractility. Promote vasodilation.
Reduce preload Diuretics such as furosemide are used in the treatment of HF to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do not directly influence afterload, contractility, or vessel tone.
The nurse conducts a complete physical assessment on a patient admitted with infective endocarditis. Which finding is significant? Respiratory rate of 18 and heart rate of 90 Regurgitant murmur at the mitral valve area Heart rate of 94 and capillary refill time of 2 seconds Point of maximal impulse palpable in fourth intercostal space
Regurgitant murmur at the mitral valve area A regurgitant murmur of the aortic or mitral valves would indicate valvular disease, which is a complication of endocarditis. All the other findings are within normal limits.
A nurse is caring for a client who has heart failure and is experiencing atrial fibrillation. The nurse should plan to monitor for and report which of the following findings to the provider immediately? Slurred speech Irregular pulse Dependent edema Persistent fatigue
Slurred speech The greatest risk to this client is injury from an embolus caused by the atrial fibrillation. Slurred speech can indicate inadequate circulation to the brain because of an embolus. The nurse should report this finding to the provider immediately.
A nurse is reviewing the medical record of a client who is receiving heparin therapy for treatment of deep-vein thrombosis. Which intervention should the nurse anticipate taking if the client's aPTT is 96 seconds?
Stop the infusion The aPTT level is above the therapeutic range of 1.5 to 2 times the control value. The nurse should discontinue the heparin infusion immediately and notify the provider to prevent harm to the client.
The patient has atrial fibrillation with a rapid ventricular response. The nurse knows to prepare for which treatment if an electrical treatment is planned for this patient? Defibrillation Synchronized cardioversion Automatic external defibrillator (AED) Implantable cardioverter-defibrillator (ICD)
Synchronized cardioversion Synchronized cardioversion is planned for a patient with supraventricular tachydysrhythmias (atrial fibrillation with a rapid ventricular response). Defibrillation or AEDs are the treatment of choice to end ventricular fibrillation and pulseless ventricular tachycardia (VT). An ICD is used with patients who have survived sudden cardiac death (SCD), have spontaneous sustained VT, and are at high risk for future life-threatening dysrhythmias.
The patient with chronic heart failure is being discharged from the hospital. What information should the nurse emphasize in the patient's discharge teaching to prevent progression of the disease to ADHF? Take medications as prescribed. Use oxygen when feeling short of breath. Only ask the physician's office questions. Encourage most activity in the morning when rested.
Take medications as prescribed The goal for the patient with chronic HF is to avoid exacerbations and hospitalization. Taking the medications as prescribed along with nondrug therapies such as alternating activity with rest will help the patient meet this goal. If the patient needs to use oxygen at home, it will probably be used all the time or with activity to prevent respiratory acidosis. Many HF patients are monitored by a care manager or in a transitional program to assess the patient for medication effectiveness and monitor for patient deterioration and encourage the patient. This nurse manager can be asked questions or can contact the health care provider if there is evidence of worsening HF.
What nursing action should the nurse prioritize during the care of a patient who has recently recovered from rheumatic fever? Teach the patient how to manage his or her physical activity. Teach the patient about the need for ongoing anticoagulation. Teach the patient about the need for continuous antibiotic prophylaxis. Teach the patient about the need to maintain standard infection control procedures.
Teach the patient about the need for continuous antibiotic prophylaxis. Patients with a history of rheumatic fever frequently require ongoing antibiotic prophylaxis, an intervention that necessitates education. This consideration is more important than activity management in preventing recurrence. Anticoagulation is not indicated in this patient population. Standard precautions are indicated for all patients.
Which statement best describes the electrical activity of the heart represented by measuring the PR interval on the ECG? The length of time it takes to depolarize the atrium The length of time it takes for the atria to depolarize and repolarize The length of time for the electrical impulse to travel from the SA node to the Purkinje fibers The length of time it takes for the electrical impulse to travel from the SA node to the AV node
The length of time for the electrical impulse to travel from the SA node to the Purkinje fibers The electrical impulse in the heart must travel from the SA node through the AV node and into the Purkinje fibers in order for synchronous atrial and ventricular contraction to occur. When measuring the PR interval (the time from the beginning of the P wave to the beginning of the QRS), the nurse is identifying the length of time it takes for the electrical impulse to travel from the SA node to the Purkinje fibers. The P wave represents the length of time it takes for the impulse to travel from the SA node through the atrium causing depolarization of the atria (atrial contraction). Atrial repolarization occurs during ventricular depolarization and is hidden by the QRS complex. The length of time it takes for the electrical impulse to travel from the SA node to the AV node is the flat line between the end of the P wave and the beginning of the Q wave on the ECG and is not usually measured.
A male patient who has coronary artery disease (CAD) has serum lipid values of LDL cholesterol 98 mg/dL and HDL cholesterol 47 mg/dL. What should the nurse include in the patient teaching? Consume a diet low in fats. Reduce total caloric intake. Increase intake of olive oil. The lipid levels are normal.
The lipid levels are normal. For men, the recommended LDL is less than 100 mg/dL, and the recommended level for HDL is greater than 40mg/dL. His normal lipid levels should be included in the patient teaching and encourage him to continue taking care of himself. Assessing his need for teaching related to diet should also be done.
A nurse is caring for a client who has a history of deep-vein thrombosis and is receiving warfarin. What client findings provides the nurse with the best evidence regarding the effectiveness of the warfarin therapy?
The nurse should determine that an INR of 2.5 is within the desired therapeutic range and is the best evidence of effective warfarin therapy.
A nurse is reviewing the ECG rhythm strip of a client who is receiving telemetry. Identify the area of the strip the nurse should examine to observe for atrial depolarization.
The nurse should examine this area of the rhythm strip to evaluate for atrial depolarization.
The nurse obtains a 6-second rhythm strip and charts the following analysis: Tab 1 Atrial data Rate: 70, regular Variable PR interval Independent beats Tab 2 Ventricular data Rate: 40, regular Isolated escape beats QRS: 0.04 sec Tab 3 Additional data P wave and QRS complexes unrelated What is the correct interpretation of this rhythm strip? Sinus arrhythmias Third-degree heart block Wenckebach phenomenon Premature ventricular contractions
Third-degree heart block Third-degree heart block represents a loss of communication between the atrium and ventricles from AV node dissociation. This is depicted on the rhythm strip as no relationship between the P waves (representing atrial contraction) and QRS complexes (representing ventricular contraction). The atria are beating totally on their own at 70 beats/min, whereas the ventricles are pacing themselves at 40 beats/min. Sinus dysrhythmia is seen with a slower heart rate with exhalation and an increased heart rate with inhalation. In Wenckebach heart block, there is a gradual lengthening of the PR interval until an atrial impulse is nonconducted and a QRS complex is blocked or missing. Premature ventricular contractions (PVCs) are the early occurrence of a wide, distorted QRS complex.
The nurse has obtained this rhythm strip from her patient's monitor. Which description of this ECG is correct? Sinus tachycardia Sinus bradycardia Ventricular fibrillation Ventricular tachycardia
This rhythm strip shows sinus tachycardia because the rate on this strip is above 101, and it displays normal P wave, PR interval, and QRS complex. Sinus bradycardia would look similar to sinus tachycardia but with a rate less than 60 beats per minute. Ventricular fibrillation does not have a measureable heart rate, PR interval, or QRS, and the P wave is not visible and the rhythm is irregular and chaotic. Ventricular tachycardia has a rate of 150 to 250 beats/minutes, with a regular or irregular rhythm and P waves occurring independently of the QRS complex.
When providing nutritional counseling for patients at risk for CAD, which foods would the nurse encourage patients to include in their diet (select all that apply)? Tofu Walnuts Tuna fish Whole milk Orange juice
Tofu Tuna fish Walnuts Tuna fish, tofu, and walnuts are all rich in omega-3 fatty acids, which have been shown to reduce the risks associated with CAD when consumed regularly.
A nurse is caring for a client who has endocarditis. Which of the following findings should the nurse recognize as a potential complication? Ventricular depolarization Guillain-Barré syndrome Myelodysplastic syndrome Valvular disease
Valvular disease Valvular disease or damage often occurs as a result of inflammation or infection of the endocardium.
A nurse is providing discharge teaching for a client who has heart failure. The nurse should instruct the client to report what finding immediately to the provider?
Weight gain of 0.9 kg (2 lb) in 24 hr When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is a weight gain of 0.5 to 0.9 kg (1 to 2 lb) in 1 day. This weight gain is an indication of fluid retention resulting from worsening heart failure. The client should report this finding immediately.