Cardiovascular and Anemia
The nurse understands that asystole can be caused by several conditions. Select all that apply. 1.Hypoxia 2.Alkalosis 3.Hypovolemia 4.Hypothermia 5. Acidosis
1 3 4 5
The nurse cares for a client following the insertion of a permanent pacemaker. What discharge instruction(s) should the nurse review with the client? Select all that apply. 1.Avoid handheld screening devices in airports 2.Refrain from walking through antitheft devices 3.Check pulse daily, reporting sudden slowing or increase 4.Avoid the usage of microwave ovens and electronic tools 5.Wear a medical alert, noting the presence of a pacemaker
1 3 5
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
1. A 14-year-old African American boy
The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for? 1.Cardiac tamponade 2.Decreased venous pressures 3.Hypertension 4.Left ventricular hypertrophy
1. Cardiac Tamponade
A 1-year-old with tetralogy of Fallot turns blue during a temper tantrum. What will the nurse do first? 1.Use a calm, comforting approach and place the child in knee-to-chest position 2.Tell the child to calm down 3.Assess the child's heart rate 4.Assess the child's respiratory rate
1. use a calm, comforting approach and place the child in knee-to-chest position
What are the major risk factors for CHD?
Age over 40 alcoholism diabetes poor nutrition during pregnancy Rubella or other viral illness during pregnancy
What are you priority's for a patient after open heart?
Ambulation up for meals encourage eating IS every hour heart pillow glucose control pain control
A parent notices that her baby passes out after crying and eating? what could this be?
Anoxic spells rf seizures, LOC or sudden death.
Treatment for Aortic stenosis?
Aortic valve replacement CABG
Your patient has symptomatic bradycardia. What do you expect to give?
Atropine Caution if w/ myocardial ischemia d/t resultant tachycardia
What is a clinical consequence of CHD?
CHF
A patient comes in with with SOB, muffled heart tones 104/64 BP. On you r assessment you notice that the BP drops > 10mmHG during inspiration. What could this be? Treatment?
Cardiac Tamponade (pulses paradoxes) *drop in BP by >10mmHg during inspiration Tx pericardiocentesis
Treatment for sickle cell anemia?
Hemopoietic stem cell transplantation Hydrea
Who is at risk for mitral regurgitation?
IV drug users genetic connective tissue "Marfans & Ehlers-Danlos"
What can mitral regurgitation lead to?
Inc LV pressure-> dec CO -> pulmonary congestion
A baby comes in with 42 RR, poor weight gain. On assessment you hear a heart murmur and the mother tells you she notices that the baby sweats with exertion while feeding. What congenital heart disease is this? Whats the treatment?
Patent Ductus Arteriosus (PDA) tx Indomethacin catheterization open chest coils
The following day the nurse notes that the friction rub is no longer present, but the heart tones appear muffled. S.T. appears mildly short of breath moving from the bed to the chair. Vital signs: 98/60, HR- 102, RR- 28, T 38.0. What could this be?
Pericardial Effusion Assessment Key -distant heart sounds -SOB -no more friction rub
S.T. is a 45 year old male who has had flu-like symptoms for the past week. He goes to see his primary care physician with a new complaint of chest pain. The pain seems to get worse with inspiration. Vital signs are 136/82, HR 92, RR-20, T- 38.5. The physician notes a pericardial friction rub. What could the diagnosis be?
Pericarditis Assessment key -pericardial friction rub -EKG-PR depression -dec pain when sitting up
A patient comes in with sickle cell disease. What are your priority concerns? R/f?
Prevent hypoxia aggressive pain control (PCA) R/F infection impaired wound healing
What are the four major effects of Tetralogy of Fallot?
Pulmonary Stenosis Right Ventricular Hypertrophy Overriding Aorta Ventricular Septal Defect
A baby comes in with a hard time breathing, not responding to parent's voice or touch. The parent tells you that lately the baby will pass out or get very fussy at times. On assessment you find the baby to have cyanosis, clubbing of fingers and hear a heart murmur. What Congential heart disease is this? What is the treatment?
Tetralogy of Fallot "TET spells" Tx palliative shunt (1st year of life) KNEE TO CHEST
What is transposition of the great arteries?
Unoxygenated blood flows to the body- cyanotic. Needs a "defect" (VSD PDA) to stay alive
Treatment for mitral regurgitation?
Valve repair annuloplasty Ring (narrows a regurgitant valve Vavle replacement
What is the most common congenital heart disease?
Ventral septal defect
A baby comes in with 34 RR, 130 HR, SOB, pale skin and delayed growth, what congenital heart disease do you expect? What are the treatment options?
Ventral septal defect tx naturally close surgery
After a trans arterial valve replacement what are your priority assessments?
assess femoral site check CMS R leg monitor for dysrhythmias
What are the signs and symptoms of transposition of the great arteries? Treatment?
blueness of skin clubbing of fingers poor feeding SOB Tx IV prostaglandin E Arterial balloon septostomy arterial switch Create a septal defect
Who is at risk for hypertrophic cardiomyopathy?
generally inherited cm: dyspnea, angina, syncope teaching: no strenuous activity, avoid dehydration
Who is at risk for dilated cardiomyopathy?
infectious myocarditis, ETOH, drugs, diabetes, pregnancy
A patient has been suspected of Mitral regurgitation, where would you listen in your assessment.
left side, 5th intercostal down, mid clavicle
What vessels are harvested for open heart surgery?
mammary artery radial artery Saphenous vein
A patient has been diagnosed with aortic stenosis, where would you listen in your assessment?
right side, 2nd intercostal down, mid clavicle
Who is at risk for restrictive cardiomyopathy?
scar tissue after MI, glycogen deposition or amyloidosis teaching: no strenuous activity, avoid dehydration.
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? 1.Cardiac tamponade 2.Fluid overload 3.Hypertension 4. Hypothermia
1. Cardiac Tamponade
The cardiac nurse is caring for a client who has been diagnosed with dilated cardiomyopathy (DCM). Echocardiography is likely to reveal what pathophysiological finding? 1.Decreased ejection fraction 2.Decreased heart rate 3.Ventricular hypertrophy 4. Mitral valve regurgitation
1. Decreased ejection fraction
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. 1.Monitor heart rate 2.Assess blood pressure 3.Track liver function studies 4.Monitor blood glucose level 5. Evaluate renal function studie
1. HR 2. BP 4. CBG
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? 1.Initiate transcutaneous pacing 2.Prepare for defibrillation 3.Administer 1mg of IV Atropine 4.Obtain a 12-lead ECG
1. Initiate transcutaneous pacing
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? 1.Metoprolol 2.Procainamide 3.Propafenone 4.Verapamil
1. Metoprolol
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? 1.Prothrombin time (PTT) 2.White blood cell (WBC) 3.Lactate 4. Arterial blood gas (ABG)
1. Prothrombin time (PTT)
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. 1.Spleen 2.Lungs 3.Central nervous system 4.Cardiac system 5.Liver
1. Spleen 2. Lungs 3. Central Nervous system
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? 1.Stay with the patient, use a calm voice, and ask for assistance via call light. 2.Notify the health care provider immediately. 3.Place the patient in the left lateral recumbent position. 4.Administer morphine by intravenous push slowly.
1. Stay with the patient, use a calm voice, and ask for assistance via call light
What disease process(es) contributes to chronic heart failure? Select all that apply. 1.Tachyarrhythmias 2.Valvular disease 3.Pancreatic disease 4.Renal failure 5.Pulmonary insufficiency
1. Tachyarrhythmias 2. valvular disease 4. Renal Failure
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. 1.Anemia 2.Lymph enlargement 3.Hypercalcemia 4.Renal dysfunction 5.Bone destructions
1. anemia 3. Hypercalcemia 4. Renal Dysfunction 5. Bone Destruction
A client is diagnosed with dilated cardiomyopathy. What is the most likely cause of the client's condition? 1.chronic alcohol use disorder 2.heredity 3.scleroderma 4.previous myocardial infarction
1. chronic alcohol use disorder
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? 1."He gets sweaty when he eats." 2."He does not seem short of breath." 3."He does not seem sick." 4."He seems to have a normal appetite."
1. he gets sweaty when he eats
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? 1."He likes to stop and squat wherever he walks." 2."He walks very quickly and never stops moving." 3."He takes one nap a day and is fairly active." 4."He does not seem to have difficulty breathing."
1. he likes to stop and squat wherever he walks
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? 1.Heparin 2.Warfarin (Coumadin) 3.Flecainide (Tambocor) 4. Dabigatran (Pradaxa)
1. heparin
What is the treatment of choice for ventricular fibrillation? 1.Immediate bystander CPR 2.Pacemaker 3.Implanted Defibrillator 4. Atropine
1. immediate bystander CPR
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? 1.Place him in a knee-chest position 2.Perform hands-on CPR 3.Administer low-dose aspirin 4. Administer prescribed amoxicillin
1. place him in a knee-chest position
An infant with tetralogy of Fallot becomes cyanotic. Which nursing intervention would be the first priority? 1.Place the infant in the knee-chest position. 2.Start an IV for fluids. 3.Prepare the infant for surgery. 4.Raise the head of the bed.
1. place the infant in the knee-chest position
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? 1.There are several reasons an infant can have a heart defect; let's talk about those causes. 2.Yes, there is a chance you caused this defect. 3.No, heart defects are mainly caused by genetic factors. 4.The studies show it is impossible to know what causes heart defects.
1. there are several reasons an infant can have a heart defect; lets talk about those causes
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? 1.Client noncompliance 2.Lead wire fracture 3.Pacer undersensing 4.Loss of pacing
2
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? 1. "We have standardized care plans for children with congenital heart defects and this nursing diagnosis is on the care plan." 2."Cardiac problems cause the heart to not pump effectively, which causes swelling in the body and fluid in the lungs." 3."The heart is a pump and it isn't pumping effectively." 4."It is a difficult process to understand. Rest assured that we are doing everything in your child's best interest."
2
A pregnant client tells her nurse that a friend of hers recently gave birth to an infant who was found to have congenital heart disease. She asks the nurse whether there is anything she can do to reduce the risk of this type of condition occurring in her baby. What information should the nurse mention to this client? 1)"Make sure you encourage a low-sodium diet in your child as he grows up." 2)"Make sure you are fully immunized." 3)"Make sure that you encourage your child to exercise as he grows up." 4)"There is really nothing you can do."
2- make sure you are fully immunized
A parent brings an infant in for poor feeding and listlessness. Which assessment data would most likely indicate a coarctation of the aorta? 1) Cyanosis with crying 2)Pulses weaker in lower extremities compared to upper extremities 3)Cyanosis with feeding 4)Pulses weaker in upper extremities compared to lower extremities
2- pulses weaker in lower extremities compared to upper extremities
The nurse is caring for an 8-month-old infant with a suspected congenital heart defect. The nurse examines the child and documents which expected finding? 1-softening of the nail beds 2-steady weight gain since birth 3- intact rooting reflex 4- appropriate mastery of development milestones
2- steady weight gain
When examining a child with congenital heart disease, an organ in the upper right quadrant of the abdomen can be palpated at 4 cm below the rib cage. What would most likely explain this assessment finding? 1) The liver size increases in right-sided heart failure. 2)The liver size increases due to cardiac medications. 3)The spleen size increases due to frequent infection. 4)The spleen size increases due to increased destruction of red blood cells.
2- the liver size increases in right sided heart failure
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? 1.learning readiness 2.cultural beliefs 3.emotional readiness 4.learning environment
2. Cultural beliefs
A nurse is caring for a client experiencing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. What condition should the nurse suspect? 1.Pulmonary embolism 2.Heart failure 3.Cardiac tamponade 4.Tension pneumothorax
2. Heart Failure
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? Select all that apply. 1.Anuria 2.Dyspnea 3.Tachycardia 4.Distant heart sounds 5.Jugular vein distention
2. dyspnea 3. tachycardia, 4. distant heart sounds 5. JVD
A child with a cardiac structural defect is receiving oxygen therapy. In which position should the child be placed to promote optimal benefits? 1.prone 2.semi-Fowler 3.side-lying 4. lithotomy
2. semi fowler
A mother asks why her infant with a cyanotic heart defect turns blue. What is the nurse's best explanation? 1.This is due to the lack of oxygen to the brain. 2.This is due to a decreased amount of oxygen to the peripheral tissue. 3.This is a sign of heart failure. 4.This is considered a medical emergency and the infant needs immediate surgery
2. this is due to a dec amount of oxygen to the peripheral tissue
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? 1. "The doctor was talking about polycythemia. It's common with this type of heart disorder." 2."It is a very complicated process. Since your child has tetralogy of Fallot, their body is overtaxed with everything it does. The amount of red blood cells being produced is just one more thing the heart has to deal with." 3."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." 4."I'm not really sure what red blood cells have to do with the heart defect your child has. We should ask your doctor."
3.
The pathophysiology of pericardial effusion is associated with all of the following except: 1.Increased right and left ventricular end-diastolic pressures. 2.Atrial compression. 3.Increased venous return. 4.Inability of the ventricles to fill adequately.
3. Increased venous return
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? 1. "That's true, but we'll make sure she gets the best intravenous nutrition." 2."Unfortunately, your baby needs more nutrients than what breast milk can provide." 3."Breast milk may help to boost her immune system, so you can continue to use it." 4."She won't be able to suck, so we have to give her fortified formula through a tube."
3. breast milk may help to boost her immune system, so you can continue to use it
A patient is admitted with suspected cardiomyopathy. What diagnostic test will the nurse need to teach the client about for identification of this disease? 1.serial enzyme studies 2.cardiac catheterization 3.echocardiogram 4. phonocardiogram
3. echocardiogram
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? 1.Cardiac catheterization 2.Computed tomography 3.Echocardiography 4.Chest x-ray
3. echocardiography
A mother is asking for more information about her infant's patent ductus arteriosus (PDA). What would be included in the education? 1.Your child may need multiple surgeries to correct this defect. 2.An IV for fluids will be started immediately. 3.This is caused by an opening that usually closes by 1 week of age. 4.This type of defect is caused by having a genetic predisposition for it
3. this is caused by an opening that usually closes by 1 week of age
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? 1."I will carry an identification card so I can avoid a handheld security device at the airport." 2."I will not be able to have a magnetic resonance imaging study." 3."I will try to have my family take a cardiopulmonary resuscitation class." 4."I will report if I feel lightheaded and dizzy at my next doctor's appointment."
4
The nurse is caring for a 6-year-old child with a congenital heart defect. To best relieve a hypercyanotic spell, what action would be the priority? 1)Administer morphine as prescribed. 2)Provide supplemental oxygen. 3)Use a calm, comforting approach. Place the child in a knee-to-chest position.
4- place the child in a knee to chest position
When assessing the client with pericardial effusion, the nurse will assess for pulsus paradoxus. Pulsus paradoxus is characterized by what assessment finding? 1.A diastolic blood pressure that is lower during exhalation 2.A diastolic blood pressure that is higher during inhalation 3.A systolic blood pressure that is higher during exhalation 4.A systolic blood pressure that is lower during inhalation
4. A systolic blood pressure that is lower during inhalation
Which nursing diagnosis should a nurse expect to see in a care plan for a client in sickle cell crisis? 1.Imbalanced nutrition: Less than body requirements related to poor intake 2.Disturbed sleep pattern related to external stimuli 3.Impaired skin integrity related to pruritus 4.Acute pain related to sickle cell crisis
4. Acute Pain related to sickle cell crisis
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? 1."It's just a coincidence; most clients with atrial fibrillation don't receive warfarin." 2."Warfarin controls heart rate in the client with atrial fibrillation." 3."Warfarin prevents atrial fibrillation from progressing to a lethal arrhythmia." 4."Warfarin prevents clot formation in the atria of clients with atrial fibrillation."
4. warfarin prevents clot formation in the atria of clients with a fib
Your patient starts to go into Supraventricular tachycardia (SVT). What do expect to give?
Adenosine (IV push over 2 sec) Repeat 12 after 1-2 min Slows conduction through AV and SA nodes
A patient comes in complaining about dizziness, leg cramps, severe headache. On assessment you find that the patient has HTN w/ BP higher in the arms than in the legs. Also weak pulse/ no pulse in the groin area. Legs/feet are cold to touch. What Congential heart disease may this be? Treatment?
Coarctation of Aorta Tx Surgery (preferred 6 months or younger) Balloon angioplasty is primary intervention for COA
What are the assessment findings indicating CHD?
vital sign changes heart murmurs cyanosis activity intolerance Growth/skill retardation Hx of frequent resp infections
