Cardiovascular Disorders

The nurse is caring for a client who is symptomatic for coronary artery disease (CAD). Which symptom(s) does the nurse expect to find when assessing this client? Select all that apply. 1. Chest pain 2. Arm pain 3. Jaw pain 4. Renal failure 5. Liver failure

1, 2, 3. Chest pain, arm pain, jaw pain, and back pain are key signs and symptoms of CAD. These can occur after exertion, emotional stress, or exposure to cold, but can also develop when the client is at rest. Renal and liver failure are not expected symptoms.

A postoperative client in ICU begins exhibiting signs of hypovolemic shock. During assessment, which symptom(s) will the nurse expect to see? Select all that apply. 1. Cold, pale, clammy skin 2. Decreased sensorium 3. Hypertension 4. Oliguria 5. Bradycardia

1, 2, 4. Key signs and symptoms of hypovolemic shock are cold, pale, and clammy skin; decreased sensorium; hypotension; reduced urine output; and tachycardia.

An adult client has a potassium level of 3.2 mEq/L (3.2 mmol/L). Which dietary recommendation is best for the nurse to provide for this client? 1. Increase consumption of bananas and oranges. 2. Avoid intake of sweet potatoes and mushrooms. 3. Increase consumption of oatmeal and apples. 4. Avoid intake of spinach and broccoli.

1. A normal serum potassium blood level is 3.5 to 5 mEq/L (3.5 to 5 mmol/L) in adult clients. Bananas, oranges, sweet potatoes, spinach, broccoli, and mushrooms are high in potassium. Oatmeal and apples are high in fiber.

The nurse recognizes a client with severe hypertension will experience increased workload that can be attributed to which process? 1. Increased afterload 2. Increased cardiac output 3. Increased preload 4. Overload of the heart

1. Afterload refers to the resistance normally maintained by the aortic and pulmonic valves, the condition and tone of the aorta, and the resistance offered by the systemic and pulmonary arterioles. Hypertension increases afterload as the left ventricle has to work harder to eject blood against vasoconstriction. Cardiac output is the amount of blood expelled from the heart per minute. Preload is the volume of blood in the ventricle at the end of diastole. Overload refers to an abundance of circulating volume and can contribute to hypertension.

The nurse understands which client is at highest risk for developing deep vein thrombosis (DVT)? 1. A 62-year-old woman recovering from a total hip replacement 2. A 35-year-old woman who is 2 days' postpartum 3. A 33-year-old male runner with Achilles tendonitis 4. An ambulatory 70-year-old man who is recovering from pneumonia

1. DVT is more common in immobilized clients who have had surgical procedures such as total hip replacement. Pregnancy can cause varicose veins, which can lead to venous stasis, but it is not a primary cause of DVT. Clients who are recovering from an injury or pneumonia may have decreased mobility, but these clients do not have the highest risk of developing DVT.

The nurse is preparing a client for surgery. Which statement by the client best indicates understanding of the surgical procedure to remove varicose veins? 1. "The surgeon will tie off a large vein in my leg and then remove it." 2. "The surgeon will use a laser to prevent further varicose veins." 3. "A piece of vein will be removed and then used to replace my blocked artery." 4. "A cold solution will be infused to shrink the vein."

1. Ligation and stripping surgically removes varicose veins. The use of laser ablation therapy will not prevent further varicose veins from developing. Veins can be used to create hypasses for blocked arteries, but this is not a treatment for varicose veins. Infusion of a cold solution is not used to treat varicose veins.

A client has been hospitalized with a diagnosis of acute arterial occlusive disease. After surgery the healthcare provider prescribes heparin IV therapy for the client. The nurse anticipates monitoring which test for this client? 1. Partial prothrombin time (PTT) 2. Complete blood count (CBC) 3. Prostate specific antigen (PSA) 4. Blood urea nitrogen (BUN)

1. PTT is used to monitor a client's response to heparin therapy and is used to evaluate all the clotting factors of the intrinsic pathway. Both are monitored whenever a client is on heparin. CBC is used to determine infection or inflammation. PSA is used to screen for prostate cancer in men. BUN is used to evaluate kidney function.

Which nursing action is priority for a client coughing up pink, frothy sputum? 1. Initiate the rapid response team. 2. Notify the healthcare provider. 3. Obtain intravenous access. 4. Suction the client's oropharynx

1. Production of pink, forthy sputum is a classic sign of acute pulmonary edema. Because the client is at high risk for decompensation, the nurse should call for help but not leave the room. The other three interventions should immediately follow.

Which task will the registered nurse (RN) delegate to the assistive personnel (AP)? 1. Take a client diagnosed with Raynaud's disease to radiology for testing. 2. Insert an indwelling catheter in a client with heart failure. 3. Explain a thoracotomy to a client diagnosed with cardiac tamponade. 4. Monitor a client with cardiomyopathy for a murmur.

1. The RN would delegate taking a stable client to another department. The AP cannot perform sterile procedures (indwelling catheter), provide education (explain procedure), or assessment (assess for a murmur).

A client with deep vein thrombosis (DVT) is admitted to the hospital for treatment. The nurse anticipates a prescription for which oral medication for this client? 1. Warfarin 2. Heparin 3. Furosemide 4. Metoprolol

1. Warfarin prevent vitamin K from synthesizing certain clotting factors. This oral anticoagulant can be given long term. Heparin is a parenteral anticoagulant that interferes with coagulation by readily combining with antithrombin; it cannot be given by mouth. Neither furosemide nor metoprolol affect anticoagulation.

The nurse is assessing a client at risk for cardiac tamponade due to chest trauma sustained in a motorcycle accident. What is the client's pulse pressure if the blood pressure is 108/82 mm Hg? Record your answer using a whole number.

26 mm Hg Pulse pressure is the difference between systolic and diastolic pressures. 108 - 82 = 26 Normally, systolic pressure exceeds diastolic pressure by about 40 mm Hg (30-50 mm Hg is normal range). Narrowed pulse pressure, a difference of less than 30 mm Hg, is a sign of cardiac tamponade.

The nurse educates a client with acute pulmonary edema that high Fowler's position is best to aid breathing. Which statement made by the client indicates an understanding of this concept? 1. "This position will allow for better access if you need to do an assessment." 2. "It will cause constriction of all of my arteries that will help my breathing." 3. "This position reduces venous return and thus will help my breathing." 4. "It will increase my heart's workload and thus make breathing easier."

3. High Fowler's position facilitates breathing by reducing venous return. It does not cause constriction of the arteries and it will not increase the workload of the heart. It may allow for better access, but this is not the reason for the position.

A client diagnosed with deep vein thrombosis (DVT) reports dyspnea, chest pain, and has diminished breath sounds. For which condition does the nurse prepare treatment? 1. Hemothorax 2. Pneumothorax 3. Pulmonary embolism 4. Pulmonary hypertension

3. The most common complication of a DVT is pulmonary embolus. A pulmonary embolism is a thrombus that forms in a vein, travels to the lungs, and lodges in the pulmonary vasculature. Hemothorax refers to blood in the pleural space. Pneumothorax is caused by an opening in the pleura. Pulmonary hypertension is an increase in pulmonary artery pressure, which increases the workload of the right ventricle.

A client with a history of hypertension had a total hip replacement. The healthcare provider prescribes hydrochlorothiazide 35 mg oral solution by mouth once per day. The label on the solution reads hydrochlorothiazide 50 mg/5 mL. How many milliliters will the nurse administer to the client? Record your answer using one decimal place.

3.5 mL

A client recovers from an episode of acute pulmonary edema and is prescribed enalapril. The nurse determines which outcome is most important for this client? 1. To decrease overload by promoting diuresis 2. To increase contractility of the heart 3. To decrease contractility of the heart 4. To decrease workload of the heart

4. Enalapril maleate is an angiotensin-converting enzyme (ACE) inhibitor that reduces blood pressure and decreases the workload of the heart. Diuretics are given to decrease circulating fluid volume. Inotropic agents increase cardiac contractility. Negative inotropic agents decrease cardiac contractility.

An adult client has experienced an episode of acute pulmonary edema. Fearful of a repeat episode, the client asks what precautions should be taken. The nurse will include which statement when providing this client education? 1. "It will be best if you limit your daily caloric intake." 2. "It is currently recommended that you restrict carbohydrates." 3. "You need to measure your weight daily in the morning and at night." 4. "Call your healthcare provider if you gain more than 3 lb (1.4 kg) in a day."

4. Gaining 3 lbs (1.4 kg) in 1 day is indicative of fluid retention that would icnrease the heart's workload, thereby putting the client at risk for acute pulmonary edema. Restricting carbohydrates would not affect fluid status. The body needs carbohydrates for energy and healing. Limiting calorie intake does not influence fluid status. The client must only be weighed in the morning after the first urination. If the client is weighed later in the day, the finding would not be accurate because of fluid intake during the day.

Which task will the registered nurse (RN) delegate to the assistive personnel (AP)? 1. Obtaining a blood pressure on a client being admitted for new onset hypertension 2. Applying oxygen to a client experiencing a myocardial infarction 3. Increasing the intravenous fluid rate for a client with hypovolemic shock 4. Taking the temperature on a client admitted yesterday for pericarditis

4. The RN will delegate taking a temperature to the AP. The AP cannot obtain initial admission vital signs as this is part of the RN's initial assessment. The AP cannot apply oxygen or titrate IV fluids.

The nurse is caring for an older adult client with sick sinus syndrome who is awaiting permanent pacemaker placement. Which assessment findings indicate to the nurse the client is experiencing an initial drop in cardiac output? 1. Decreased blood pressure 2. Altered level of consciousness (LOC) 3. Decreased blood pressure and diuresis 4. Increased blood pressure and fluid volume

4. The body compensates for a decrease in cardiac output with a rise in blood pressure (due to the stimulation of the sympathetic nervous system) and an increase in fluid volume as the kidneys retain sodium and water. Blood pressure does not initially drop in response to the compensatory mechanism of the body. Alteration in LOC will occur only if decreased cardiac output persists.

A client has undergone ligation of stripping of veins in the lower extremities. Which intervention will the nurse complete for this client? 1. Have the client sit for most of the day. 2. Maintain the client on strict bed rest. 3. Apply ice packs to the lower extremities. 4. Apply thigh-high elastic leg compressions.

4. Thigh-high elastic leg comrpessions helps venous return to the heart, thereby decreasing venous stasis. Prolonged sitting and bed rest are contraindicated because both promote decreased blood return to the heart and venous stasis.Although ice packs would help reduce edema, they would also cause vasoconstriction and impede blood flow.

The nurse is caring for a client diagnosed with myocardial infarction (MI) who is prescribed a nitrate. What does the nurse identify as the purpose of giving a nitrate to this client? 1. Relieve pain. 2. Dilate coronary arteries. 3. Relieve secondary headaches. 4. Calm and relax the client.

2. Nitrates dilate the arteries, allowing oxygen to continue flowing to the myocardium. Nitrates can cause headaches but do not relieve pain, and they do not calm or relax the client.

The nurse is providing discharge education for a client with varicose veins. Which statement by the client indicates a need for further instruction? 1. "Exercise will make me feel better." 2. "I have to elevate my legs." 3. "Lying down can relieve my symptoms." 4. "Wearing tight clothes will not affect me."

4. Tight clothing, especially below the waist, increases vascular volume and impedes blood return to the heart. Exercise, leg elevations, and lying down usually relieve symptoms of varicose veins.

An adult client with heart failure and 2+ pitting edema is prescribed furosemide. Which supplemental medication does the nurse expect will be prescribed for this client? 1. Chloride 2. Digoxin 3. Potassium 4. Sodium

3. Supplemental potassium is given with furosemide because potassium loss occurs as a result of this diuretic. Chloride and sodium are not lost during diuresis. Digoxin acts to increase contractility but is not given routinely with furosemide.

A client is admitted to the hospital displaying sinus bradycardia, nausea, anorexia, and blurred vision. The nurse anticipates treating the client for which condition? 1. Digoxin toxicity 2. Myocardial infarction 3. Hypertensive crisis 4. Cor pulmonale

1. Dixogin toxicity typically causes bradycardia, nausea, anorexia, and vision disturbances. An MI, hypertensive crisis, and cor pulmonale usually do not cause vision disturbance.

A client who is very anxious often comes to the emergency department with reports of chest pain rated a "5" on a scale of 0 to 10. The nurse will assess this client for which condition? 1. Anxiety 2. Stable angina 3. Unstable angina 4. Variant angina

2. The pain of stable angina is predictable in nature, builds gradually, and quickly reaches maximum intensity. Anxiety generally is not described as painful. Unstable angina does not always need a trigger, is more intense, and lasts longer than stable angina. Variant angina usually occurs at rest not as a result of exertion or stress.

When educating a client about the importance of smoking cessation, which statement(s) made by the client indicates to the nurse the education is understood? Select all that apply. 1. "It causes platelets in the blood to clump together and become sticky." 2. "It causes spasms in the coronary arteries to occur." 3. "Clients who smoke have lower high-density lipoprotein levels." 4. "Smoking causes vasodilation of the arteries." 5. "It reduces the amount of oxygen carried by red blood cells."

1, 2, 3, 5. Smoking is the leading modifiable risk factor for developing coronary heart disease. Smoking causes the platelets of the blood to clump together, causes spasms in the coronary arteries, lowers good cholesterol, causes vasoconstriction, and reduces the amount of oxygen carried in the red blood cells.

A client is seen in the emergency department and the healthcare provider suspects an abdominal aortic aneurysm. Which action(s) is priority for the nurse to perform? Select all that apply. 1. Monitor and record vital signs. 2. Monitor intake, output, and laboratory values. 3. Observe client for signs of hypovolemic shock. 4. Apply a non-rebreather oxygen mask. 5. Prepare the client for an abdominal ultrasound.

1, 2, 3, 5. The nurse should monitor and record vital signs, monitor input and output as well as laboratory values, observe the client for hypovolemic shock in case the aneurysm has ruptured, prepare for testing. An abdominal ultrasound is commonly used to diagnose an abdominal aortic aneurysm. There is no indication in the scenario that the client needs oxygen at this time.

The client is prescribed amlodipine. Which primary action(s) will the nurse discuss with the client? Select all that apply. 1. Dilation of arteries 2. Decreased peripheral vascular resistance 3. Increases overload 4. Reduces afterload 5. Promotes calcium influx

1, 2, 4. Amlodipine is a calcium channel blocker, which inhibits calcium influx through the coronary arteries, causing arterial dilation and decreasing peripheral vascular resistance, which reduces afterload. Impulse conduction is slowed when calcium flow into cardiac cells is inhibited and contractility is decreased.

The nurse is auscultating a client's heart and identifies a third heart sound. Which additional finding(s) will the nurse expect to assess? Select all that apply. 1. Dyspnea while supine 2. Bradycardia 3. Persistent cough with pink sputum 4. Nocturnal polydipsia 5. Increased hunger 6. Rapid weight gain

1, 2, 4, 6. An S3 sound occurs when the ventricles are resistant to filling and is heard just after S2 when the atrioventricular valves open. The most common cause is congestive heart failure, which the nurse would expect to assess in this client is dyspnea while supine or with exertion. Tachycardia, not bradycardia, is expected. A persistent cough with white or blood-tinged sputum, nocturnal polydipsia, and rapid weight gain are expected. A lack of appetite is common.

A healthy, pregnant woman is diagnosed with varicose veins. What education will the nurse provide to this client? Select all that apply. 1. Elevate legs periodically. 2. Change positions often. 3. Monitor weight daily. 4. Wear ankle-high socks. 5. Drink 64 oz of water per day.

1, 2, 3. Primary varicose veins have a gradual onset and progressively worsen. To help prevent or lessen the effects of varicose veins during pregnancy, the client should elevate legs to help promote circulation, change position frequently, and monitor weight, as a large weight gain in a short period of time is hard on the veins. The client should use support panty hose or stockings, not ankle socks, to help prevent varicose veins, and should take steps to avoid constipation as this can lead to hemorrhoids. The pregnant client should drink at least 96 oz of water daily.

A client with heart failure is experiencing symptoms of cardiogenic shock. Which symptom(s) will the nurse expect this client to exhibit? Select all that apply. 1. Tachycardia 2. Hypotension 3. Bradycardia 4. Decreased peripheral pulses 5. Tachypnea

1, 2, 4, 5. Cardiogenic shock is related to ineffective pumping of the heart and is an acute and serious complication of heart failure. Symptoms include tachycardia, decreased blood pressure, tachypnea, and decreased peripheral pulses. Bradycardia is not associated with this disease process.

Which area(s) on the precordium will the nurse use for auscultation of heart sounds. Select all that apply. 1. Aortic area 2. Pulmonic area 3. Erb's point 4. Mitral area 5. Tricuspid area 6. Bronchial area

1, 2, 3, 4, 5. The correct landmarks that can be used for auscultation of heart sounds are the aortic area, pulmonic area, Erb's point, tricuspid area and mitral area. Bronchial area is not appropriate.

The nurse is educating a client recently diagnosed with deep vein thrombosis (DVT). Which statement made by the client indicates to the nurse a need for further education? 1. "I will wear compression stockings at night." 2. "I will elevate my legs if I note swelling." 3. "I will be sure to walk every hour." 4. "I will not wear tight-fitting pants."

1. Compression stockings should be worn during the day and removed at night. The client should elevate lower extremities to promote circulation and decrease edema. If sitting for extended times, the client should ambulate hourly. Tight clothing can restrict circulation.

A client comes to the emergency department reporting chest pain. Upon further assessment the client is diagnosed with unstable angina. The nurse understands additional education is needed if the client makes which statement regarding measures to prevent a common complication associated with unstable angina? 1. "I will take aspirin 325 mg with each meal." 2. "I will not drink alcohol while I take aspirin." 3. "I will stop eating fried foods and limit red meat intake." 4. "I need to work on managing my stress level."

1. Unstable angina progressively increases in frequency, intensity, and duration and is related to an increased risk of MI within 3 to 18 months. The nurse would educate the client on measures to decrease the risk of a future MI. It is recommended to take a blood thinner, such as aspirin for angina, to promote blood flow. The client should take 81 to 325 mg aspirin once daily, not TID. It is recommended to eat healthy; reduce stress; exercise; stop smoking; and monitor blood pressure, glucose, and cholesterol levels to reduce a client's risk of having an MI.

While the nurse is assessing a client, the client states, "Sometimes my heart seems to race." The nurse will be especially vigilant to assess this client for which cardiac arrhythmia? 1. Ventricular fibrillation 2. Sinus tachycardia 3. Atrial fibrillation 4. Atrial flutter

1. Ventricular fibrillation is a life-threatening arrhythmia. It occurs when the ventricle fibrillates, failing to fully contract and pump blood through the heart. Sinus tachycardia, atrial fibrillation, and atrial flutter are arrhythmias that may require treatment but are not considered life-threatening.

Which nursing action is priority when caring for a client exhibiting manifestations of coronary artery disease? 1. Decrease anxiety level. 2. Enhance myocardial oxygenation. 3. Administer sublingual nitroglycerin. 4. Educate the client about symptoms.

2. Enhancing myocardial oxygenation is always the priority when a client exhibits manifestations of cardiac compromise. Without adequate oxygen, the myocardium suffers damage. Sublingual nitroglycerin dilates the coronary vessels to increase blood flow, but its administration is not the priority. Although educating the client and decreasing anxiety are important, neither are priority for a compromised client.

The nurse is caring for a client just diagnosed with a 3-cm infrarenal abdominal aortic aneurysm (AAA). Which nursing statement(s) will be included when educating this client? Select all that apply. 1. "AAAs occur more commonly above the level of the renal artery origins." 2. "AAAs occur more commonly in men than they do in women." 3. "AAAs are rarely linked to genetic factors." 4. "A client with an AAA may also have 'blue toe syndrome'." 5. "A 3-cm AAA rarely causes symptoms such as back pain."

2, 4, 5. An AAA is more than twice as common in men as women and up to 28% of these clients have a first-degree family member with an AAA. Small AAAs (less than 4 cm) are commonly identified coincidentally and are usually asymptomatic. Larger AAAs may be lined with an intraluminal thrombus, and "blue toe syndrome" occurs when the thrombus from the aneruysm microembolizes to the foot.

What is the nurse's first intervention for a client experiencing a myocardial infarction (MI)? 1. Give morphine intravenously. 2. Apply oxygen via a facemask. 3. Provide sublingual nitroglycerin. 4. Administer aspirin.

2. Administering supplemental oxygen to the client is the first priority of care. The myocardium is deprived of oxygen during an infarction, so additional oxygen is administered to assist in oxygenation and prevent further damage. Next, the nurse will give nitroglycerin, followed by aspirin, and last is morphine. Remember the acronym ONAM (oxygen, nitroglycerin, aspirin, morphine) for clients experiencing an MI.

A client diagnosed with acute arterial occlusive disease is scheduled to undergo an atherectomy. What is the priority nursing intervention for this client immediately after the procedure? 1. Monitor vital signs every hour. 2. Closely monitor the site for bleeding. 3. Ambulate the client as soon as possible. 4. Teach client about the importance of exercise.

2. Atherectomy is a surgical treatment used for acute arterial occlusive disease. After the procedure, the client should be monitored frequently for bleeding at the catheter site and vital signs should be taken every 15 minutes times four, and then every hour for the first few hours. Ambulation should be delayed for the first 12 hours, and exercise is not a priority at this time.

The registered nurse (RN) delegates obtaining a client's blood pressure to the assistive personnel (AP). Which action by the AP warrants immediate intervention by the RN? 1. Applies clean gloves before applying the blood pressure cuff 2. Placing stethoscope over the brachiocephalic artery 3. Uses diaphragm of the stethoscope for auscultation 4. Washes hands before taking the blood pressure

2. The brachiocephalic artery is not accessible for blood pressure measurement. The brachial artery is typically used because of its easy accessibility and location. Gloves are not required when assessing a client's blood pressure unless the nurse expects to come in contact with blood or body fluids. However, immediate intervention is not required for using gloves. The AP uses standard precautions by washing hands whenever performing skills, and the diaphragm is the correct part of stethoscope to use when taking a blood pressure.

The nurse is caring for a client with cardiac tamponade. Which finding(s) will the nurse expect to assess on this client? Select all that apply. 1. Paradoxical chest movement 2. Tracheal deviation 3. Pulsus paradoxus 4. Light-headedness 5. Narrowing pulse pressure 6. Muffled heart sounds

3, 4, 5, 6. Pulsus paradoxus is a symptom of cardiac tamponade caused by a marked decrease in cardiac output, which results in a diminished pulse and decreased blood pressure during inspiration. Light-headedness, narrowing pulse pressure, and muffled heart sounds are additional signs of cardiac tamponade. Paradoxical chest movement occurs with flail chest. Tracheal deviation is seen with tension pneumothorax.

When assessing a client admitted with a blood pressure of 154/96 mm Hg, the nurse will expect the client to report which symptom? 1. Blurred vision 2. Epistaxis 3. Headache 4. Peripheral edema

3. An occipital headache is typical of hypertension owing to increased pressure in the cerebral vasculature. Blurred vision (due to arteriolar changes in the eye) and epistaxis (nosebleed) are far less common than headache can also be diagnostic signs. Peripheral edema can occur from an increase in sodium and water retention, but it is usually a latent sign.

The client diagnosed with hypertension asks the nurse, "Will this condition affect my eye sight?" Which statement by the nurse is most appropriate? 1. "If you keep your hypertension controlled, you do not need to worry about your vision." 2. "Yes, you need to have your eyes checked every 6 months." 3. "To assess for changes, you need to have your eyes checked annually." 4. "You will be referred to an ophthalmologist who can detect changes in your eyes."

3. Because hypertension can negatively affect eye sight, annual eye exams are recommended to allow for early intervention. Biannual exams are not currently recommended. Telling the client not to worry or that he or she will receive a referral does not address the client's concern.

A client is admitted to the emergency department with a suspected diagnosis of shock. The nurse will anticipate preparing the client for which procedure? 1. Arterial line placement. 2. Indwelling urinary catheter insertion 3. Intra-aortic balloon pump (IABP) placement 4. Pulmonary artery (PA) catheterization

4. A PA catheterization is performed to obtain accurate pressure measurements within the heart, which aids in diagnosing and determining the course of treatment. An arterial line is used to directly assess blood pressure continuously. An indwelling urinary catherter is used to drain the bladder. An IABP is an assistive device used to rest the damaged heart.

A client, 1 hour after undergoing a cardiac catheterization through a percutaneous femoral access site, reports, "There is something wet under my buttocks." Upon entering the client's room, what is the priority nursing action? 1. Reinforce the groin dressing. 2. Obtain the client's vital signs. 3. Reposition the client in bed. 4. Assess the femoral access site.

4. Assessing the femoral access site for potential bleeding is the priority. Reinforcing the groin dressing may be necessary after the site is assessed. Obtaining vital signs is not the priority at this time. After a femoral puncture, the client is usually prescribed complete bed rest with the affected leg straight and immobilized for 2 to 4 hours to reduce the risk of bleeding.

A client is admitted to the emergency department with chest discomfort, diaphoresis, and nausea. Suspecting possible myocardial infarction (MI), the nurse prepares the client for which test first? 1. Cardiac catheterization 2. Cardiac enzymes 3. Echocardiogram 4. Electrocardiogram (ECG)

4. ECG is the quickest, most accurate, and most widely used tool to diagnose an MI. Cardiac enzymes are also used to diagnose MI, but the results cannot be obtained as quickly. An echocardiogram is used most widely to view myocardial wall function after an MI has been diagnosed. Cardiac catheterization is an invasive study for determining coronary artery disease.

Which symptom(s) does the nurse expect a client with right-sided heart failure to exhibit? Select all that apply. 1. Jugular vein distention (JVD) 2. Peripheral edema 3. Hepatomegaly 4. Fatigue 5. Crackles

1, 2, 3, 4. During right-sided heart failure, the right ventricle fails to empty adequately, causing a backup of blood into systemic blood vessels. This can lead to jugular vein distention, peripheral edema, fatigue, and hepatomegaly. Crackles are a symptom of left-sided heart failure.

A client is having an acute myocardial infarction (MI). Which prescription(s) will the emergency room nurse complete? Select all that apply. 1. Prepare the client for an angioplasty. 2. Administer intravenous morphine. 3. Apply a 12-lead electrocardiogram. 4. Administer aspirin orally. 5. Provide oxygen therapy.

1, 2, 3, 4, 5. An angioplasty may be done to unblock the arteries. Morphine is administered as analgesia because chest pain stimulates the sympathetic nervous system, leading to an increase in heart rate and vasoconstriction. In addition, morphine will reduce anxiety and the workload of the heart; however, the primary indication to administer morphine is to relieve chest pain. An EKG will assist in determining which area of the heart was affected and to monitor the heart. Aspirin is given to prevent platelet aggregation. Oxygen is given to assist in tissue perfusion.

The nurse is caring for a client with a 7-cm infrarenal abdominal aortic aneurysm (AAA). The computed tomography (CT) scan indicates the aneurysm may be leaking. When performing an assessment on the client, the nurse will expect which finding(s)? Select all that apply. 1. Constant, severe lower back pain 2. Constant, "tearing" abdominal sensation 3. Blood pressure 86/52 mm Hg 4. Decreased red blood cell (RBC) count 5. Weak or absent bilateral leg pulses 6. Intermittent, mild epigastric pain

1, 2, 3, 4, 5. Severe, constant lower back pain or constant "tearing" abdominal pain indicates a leaking or ruptured aneurusm as blood enters the abdominal cavity and retroperitoneal space. The client's blood pressure and RBC count will fall as the client becomes hypovolemic from hemorrhage. Diminished blood flow through the iliac and femeral arteries causes weak or absent bilateral leg pulses. Pain from a leaking or ruptured aneruysm is constant.

A client arrives in the emergency department and is diagnosed with unstable angina. Which nursing intervention(s) is priority for this client? Select all that apply. 1. Apply oxygen. 2. Administer aspirin. 3. Give nitroglycerin. 4. Apply cardiac monitor. 5. Provide nutrition counseling. 6. Provide smoking cessation education.

1, 2, 3, 4. The initial treatment consists of administration of oxygen, aspirin, nitroglycerin, and a beta-blocker, and application of a cardiac monitor. Given an altered, yet nondiagnostic ECG and no contraindications, further treatment with heparin (low molecular weight or unfractionated), clopidogrel, or other antiplatelet agents may be initiated. Most often, an additional abnormal marker (e.g., an elevated serum troponin, myoglobin, or CPK level) will be verified prior to antiplatelet therapy. Education on nutrition and smoking cessation would be provided once the client is stabilized.

A client is diagnosed with valvular heart disease with a primary symptom of fatigue. Which disease process does the nurse suspect the client is experiencing? Select all that apply. 1. Aortic insufficiency 2. Mitral insufficiency 3. Mitral valve prolapse 4. Mitral stenosis 5. Tricuspid insufficiency

1, 2, 3, 5. A key symptom of aortic insufficiency, mitral insufficiency, mitral stenosis, and tricuspid insufficiency is fatigue. Palpitations are usually the only symptom for mital valve prolapse.

A client with a family history of heart disease is diagnosed with coronary artery disease (CAD). The client asks the nurse, "How might this affect my future health status?" Which nursing response(s) is appropriate? Select all that apply. 1. "It can lead to hypertension." 2. "It can lead to angina." 3. "It can lead to myocardial infarction (MI)." 4. "It can lead to gastritis." 5. "It can lead to heart failure."

1, 2, 3, 5. Coronary artery disease causes decreased perfusion of myocardial tissue and inadequate myocardial oxygen supply. This can cause hypertension, angina, MI, heart failure, and even death. Causes of gastritis, the inflammation of the stomach lining, include infection, injury, regular use of NSAIDs, and excessive alcohol consumption.

A client demonstrates signs of cardiogenic shock. Which medication(s) will the nurse expect the healthcare provider to prescribe for this client? Select all that apply. 1. Digoxin 2. Dopamine 3. Furosemide 4. Clopidogrel 5. Nitroprusside sodium

1, 2, 3, 5. Medications given for cardiogenic shock include a cardiac glycoside (digoxin), a cardiac inotropic agent (dopamine), a diuretic (furosemide), and a vasodilator (nitroprusside sodium). The client does not indicate a need for an antiplatelet aggregate such as clopidogrel.

A client is diagnosed with a 4.5-cm infrarenal abdominal aortic aneurysm (AAA). Which statement(s) will the nurse include when teaching the client? Select all that apply. 1. "Controlling blood pressure and lipid levels helps to slow aneurysm expansion." 2. "An AAA will be monitored for expansion every 6 to 12 months." 3. "Smoking has no effect on the rate of aneurysm expansion." 4. "Genetic factors influence the development of AAA." 5. "All AAAs need to be repaired as soon as they are identified."

1, 2, 4. Multiple factors lead to arterial wall damage and aneurysm formation. These include heredity, atherosclerosis, infection, smoking, and hypertension; therefore, controlling these factors help to slow progression. Clients with AAAs of 4 to 5.4 cm should be monitored for expansion of the aneurysm using ultrasound or computed tomography (CT) scan every 6 to 12 months. The average aneruysm expansion rate is 10% per year but the rate of expansion is highly individual; many AAAs remain stable without expansion for many years.

The nurse will recommend which activity for a client at risk of developing hypertension? Select all that apply. 1. Maintain a healthy weight for height. 2. Attend smoking cessation classes. 3. Participate in physical activity once per week. 4. Eat a diet low in sodium and high in potassium. 5. Drink less than three alcoholic beverages per day.

1, 2, 4. Risk factors for hypertension include obesity, smoking, heredity, diabetes, and a lack of exercise, among other factors. Activities to help the client decrease risk factors include maintaining a healthy weight, stopping smoking, participating in physical activity at least three times per week, not once, eating a diet low in sodium and high in potassium (helps keep blood pressure low), and limiting alcohol consumption. Three alcoholic beverages per day is excessive.

Which finding(s) most concerns the nurse caring for a preoperative adult client with an abdominal aortic aneurysm (AAA)? Select all that apply. 1. Clammy skin 2. Sudden back pain 3. Pulsation near the umbilicus 4. Pulse 88 bpm 5. Blood pressure 84/46 mm Hg 6. Intermittent, dull abdominal pain

1, 2, 5. Clammy skin; sudden, intense, and persistent abdominal or back pain that is described as a tearing sensation; hypotension; and tachycardia are indications that an AAA has ruptured. Rupture of the aneuysm is a life-threatening emergency. A pulsation and dull, intermittent, or constant abdominal or back pain are expected findings with an AAA. A heart rate of 88 bpm is within normal range.

An adult client is admitted to an acute care floor with the diagnosis of heart failure. Upon further workup the healthcare provider informs the nurse that the client has right-sided heart failure. Which symptom(s) does the nurse expect to assess in this client? Select all that apply. 1. Dependent edema 2. Jugular vein distention 3. Weight loss 4. Crackles 5. Weight gain

1, 2, 5. Signs of right-sided heart failure include dependent edema, jugular vein distention, and weight gain. Crackles are a sign of left-sided heart failure. Weight loss is not an indication of heart failure.

A client is placed on lisinopril to reduce blood pressure. The nurse understands which hormone(s) is associated with this medication and is responsible for preventing peripheral vasoconstriction? Select all that apply. 1. Angiotensin I 2. Angiotensin II 3. Epinephrine 4. Norepinephrine 5. Aldosterone

1, 2. An ACE inhibitor inhibits the renin-angiotensin-aldosterone system by blocking conversion of angiotensin I to angiotensin II and helps to prevent vasoconstriction. ACE inhibitors do not have an effect on epinephrine, norepinephrine, or aldosterone.

A client with coronary artery disease (CAD) comes to the clinic with a total serum cholesterol level of 240mg/dL (6.22 mol/L). Which medication(s) does the nurse anticipate the healthcare provider will prescribe? Select all that apply. 1. Cholestyramine 2. Lovastatin 3. Atenolol 4. Propanolol 5. Metoprolol

1, 2. Cholestyramine and lovastatin help to lower total cholesterol. Atenolol, propanolol, and metroprolol are not used to lower cholesterol, but prescribed to lower blood pressure and decrease tachycardia.

The nurse administers atenolol to a client diagnosed with cardiomyopathy. What finding(s) indicates to the nurse that atenolol is appropriate for this client? Select all that apply. 1. Improved cardiac output 2. Improved myocardial filling 3. Increasing contractility 4. Increased blood pressure 5. Increased heart rate

1, 2. The healthcare provider may prescribe medications to improve the heart's pumping ability and function, improve blood flow, lower blood pressure, slow the heart rate, remove excess fluid from the body, or keep blood clots from forming. By decreasing the heart rate and contractility, beta-blockers, such as atenolol, improve myocardial filling and cardiac output, which are primary goals in the treatment of cardiomyopathy.

A client is admitted with suspected cardiac tamponade. Which symptom(s) will the nurse expect to assess in this client? Select all that apply. 1. Muffled heart sounds 2. Wide pulse pressure 3. Jugular vein distention 4. Restlessness 5. Pulsus paradoxus

1, 3, 4, 5. Key signs and symptoms of cardiac tamponade are muffled heart sounds upon auscultation, narrow pulse pressure, jugular vein distention, pulsus paradoxus (an abnormal inspiratory drop in systemic blood pressure greater than 15 mm Hg), restlessness, and sitting upright or leaning forward.

Which intervention is best for the nurse to suggest to a client who has a serum total cholesterol level of 250 mg/dL (6.47 mmol/L)? 1. Limit fats and carbohydrates. 2. Eat more animal meat and dairy. 3. Limit consumption of raw fruits. 4. Increase fresh vegetables each day.

1. A change in diet would be the best intervention and should include limited fats and carbohydrates. Total cholesterol levels above 240 mg/dL (6.22 mmol/L) are considered high; they require dietary restriction and, perhaps, medication. Eating more protein or limiting fruits will not help decrease the level. Eating more vegetables could be a good thing but does not guarantee a decrease in cholesterol.

The nurse is providing education to a client about warfarin. Which statement by the client best indicates to the nurse an understanding of warfarin? 1. "I should use a soft toothbrush." 2. "I can expect to have bruising." 3. "I will adjust my diet to eat less protein." 4. "I should use a safety razor to shave."

1. A soft toothbrush will help prevent bleeding from friable gum tissue. Increased bruising should be reported to the healthcare provider. Dietary adjustments include consuming consistent amounts of dark green, leafy vegetables, which are high in vitamin K, but do not include protein restriction. Electric razors are recommended to reduce the risk of cutting the skin.

A client with a history of chronic obstructive pulmonary disease (COPD) arrives in the emergency department with an oxygen saturation of 84% on room air. Which procedure does the nurse anticipate preparing the client for next? 1. Arterial blood gas (ABG) 2. Complete blood count (CBC) 3. Electrocardiogram (ECG) 4. Lung scan

1. ABG levels reflect cellular metabolism and indicate hypoxia. A CBC is performed to determine various constituents of venous blood. An ECG shows the electrical activity of the heart. A lung scan is performed to view the lungs' function.

The nurse is preparing to administer digoxin to a client. What will the nurse do before administering digoxin? 1. Assess an apical pulse. 2. Monitor the blood pressure. 3. Weigh the client. 4. Check the respiratory rate.

1. An apical pulse is essential for accurately assessing the client's heart rate before administering digoxin. The apical pulse is the most accurate pulse point in the body. An apical pulse should be checked for 1 minute prior to administration. The nurse will withhold digoxin and notify the healthcare provider if the pulse is <60 bpm in an adult. Blood pressure is monitored periodically, as it usually is only affected if the heart rate is too low, in which case the nurse would withhold digoxin. The client is generally weighed daily but does not have to be weighed at the time of medication administration. Digoxin has no effect on respiratory function.

The nurse has provided education about angina to a client who has pain from angina. Which statement made by the client indicates a need for further teaching? 1. "Angina pain is relieved with nitroglycerin." 2. "Angina pain can develop slowly or quickly." 3. "I may feel angina pain in my shoulders, neck, arms or back." 4. "Angina pain usually lasts less than 5 minutes."

1. Angina pain, if unstable, may or may not be relieved by nitroglycerin. It can develop slowly or quickly, and it can radiate to arms, neck, shoulders and back. Angina pain usually lasts only 5 minutes but can last up to 15 to 20 minutes. It can also be described as mild or moderate.

The nurse receives report on a client who has been diagnosed with an abdominal aortic aneurysm (AAA). The nurse will expect the client to have which underlying disease? 1. Atherosclerosis 2. Type 1 diabetes 3. Chronic obstructive pulmonary disease (COPD) 4. Renal failure

1. Atherosclerosis is linked to 75% of all AAAs. Plaque damages the wall of the artery and weakens it, causing an aneurysm. Although the other conditions are related to the development of aneurysms, none are a direct cause.

The nurse is caring for a client with cardiomyopathy. For which condition will the nurse closely assess the client? 1. Heart failure 2. Diabetes 3. Myocardial infarction (MI) 4. Pericardial effusion

1. Because the structure and function of the heart muscle is affected, heart failure most commonly occurs in clients with cardiomyopathy. MI results from atherosclerosis. Pericardial effusion is most predominant in clients with pericarditis. Diabetes is unrelated to cardiomyopathy.

A client is admitted with a diagnosis of post-thrombotic deep vein changes in both legs. Which assessment findings will the nurse expect to assess in this client? 1. Edema and pigmentation 2. Pallor and severe pain 3. Severe pain and edema 4. Absent hair growth and pigmentation

1. Blood clots in the deep veins of the leg typically cause permanent damage to the venous valves. Incompetent valves lead to impaired venous return, and edema and pigmentation result from venous stasis. Severe pain, pallor, and absent hair growth are symptoms of an altered arterial blood flow.

An adult client is newly diagnosed with left-sided heart failure. Which sign, most commonly associated with this type of heart failure, will the nurse expect to note when assessing this client? 1. Crackles 2. Arrhythmias 3. Hepatic engorgement 4. Hypotension

1. Crackles in the lungs are a classic sign of left-sided heart failure. These sounds are caused by fluid backing up into the pulmonary system. Arrhythmias can be associated with right- and left-sided heart failure. Hepatic engorgement is associated with right-sided heart failure. Left-sided heart failure causes hypertension, not hypotension, secondary to an increased workload on the system.

A client is suspected of having cardiogenic shock. Which medication does the nurse anticipate administering to the client? 1. Dopamine 2. Enalapril 3. Furosemide 4. Metoprolol

1. Dopamine, a sympathomimetic drug, improves myocardial contractility and blood flow through vital organs by increasing perfusion pressure. Enalapril is an angiotensin-converting enzyme (ACE) inhibitor that directly lowers blood pressure. Furosemide is a diuretic and does not have a direct effect on contractility or tissue perfusion. Metoprolol is a beta-blocker that slows the heart rate and lowers blood pressure, neither of which is a desired effect in the treatment of cardiogenic shock.

The nurse is admitting a client to the medical unit. Which client statement indicates to the nurse the client may have varicose veins? 1. "When I walk or stand for a long time, my legs feel tired and have a dull ache." 2. "My foot pain gets better if I dangle my foot off the edge of the bed." 3. "My legs become numb and get weaker the farther I walk." 4. "After I walk 1/2 mile (800 m) I get severe calf pain that goes away when I rest."

1. Fatigue, aching, and pressure are classic symptoms of varicose veins, secondary to increased blood volume and edema. Severe foot pain that is relieved by dangling from the bed or chair, as well as severe calf pain after walking that is relieved with rest, are symptoms of decreased peripheral arterial blood flow. Numbness and weakness that increase as the client walks are consistent with spinal stenosis.

The nurse is educating a client with a history of diabetes who has been prescribed furosemide for new onset hypertension. Which statement made by the client indicates to the nurse additional education is needed? 1. "If I miss a pill, I will take two when the next dose is scheduled." 2. "I will closely monitor my glucose levels while taking furosemide." 3. "If I have trouble swallowing this pill, I can crush it and take with food." 4. "I will move slowly when I am changing my position."

1. Furosemide is a loop diuretic that inhibits sodium and water reabsorption in the loop of Henle, thereby causing a decrease in blood pressure. If a dose is missed, it should be taken as soon as possible, but the dose should not be doubled. Furosemide can cause glucose levels to increase in clients with diabetes. Furosemide can be crushed and taken with food. It can cause orthostatic hypotension; therefore, slow movements are best.

The nurse is obtaining a client's blood pressure and hears a faint, clear tapping sound. What will the nurse do next? 1. Continue obtaining the blood pressure. 2. Call the healthcare provider. 3. Notify the rapid response team. 4. Determine if the client recently had an MI.

1. Initially, auscultation produces a faint, clear tapping sound that gradually increases in intensity. Therefore, the nurse should continue to listen. It is not necessary to call the healthcare provider, call a rapid response, or determine if the client has had an MI at this time.

Which client does the nurse identify as having the greatest chance of developing cardiogenic shock? 1. A client who had an acute myocardial infarction (MI) 2. A client diagnosed with coronary artery disease (CAD) 3. A client whose hemoglobin level is 10 g/dL (100 g/L) 4. A client with blood pressure of 92/56 mm Hg

1. Of all clients with an acute MI, 15% suffer cardiogenic shock secondary to the myocardial damage and decreased function. CAD causes MI. Hypotension is the result of a reduced cardiac output produced by the shock state. A decreased hemoglobin level is a result of bleeding.

A client with varicose veins is admitted for right leg vein ligation and stripping. The nurse will perform which intervention postoperatively? 1. Have the client elevate the legs when sitting. 2. Have the client remain inactive until healed. 3. Apply knee-high stockings over the dressing. 4. Apply ice packs to the client's dressings.

1. Posoperative nursing interventions must focus on maintaining peripheral circulation and venous return. Elevating the legs and early ambulation are encouraged to facilitate venous return. Applying knee-high stockings and ice would constrict circulation.

A client calls the nurse and states, "I think I am having bad indigestion because my chest hurts." Which response by the nurse is most appropriate? 1. "Immediately go to the hospital." 2. "Have you ever felt this way before?" 3. "What did you eat yesterday?" 4. "Take an antacid and see if it subsides."

1. The most common symptom of an myocardial infarction is chest pain resulting from deprivation of oxygen to the heart. The nurse would inform the client to seek medical help immediately. All other responses are inappropriate as postponing care could lead to serious complication or even death.

The emergency room nurse assesses a client and notes: clammy skin, blood pressure 68/42 mm Hg, labored breathing, and pulse 134 beats/minute. What will the nurse do next? 1. Apply oxygen. 2. Monitor vital signs. 3. Obtain arterial blood gas (ABG) levels. 4. Prepare for an angioplasty.

1. The nurse will first apply oxygen to the client as this client is exhibiting signs of cardiogenic shock. The nurse will monitor vital signs and ABG levels. An angioplasty may be needed for stent placement. However, these actions are not priority.

The nurse is caring for a client newly diagnosed with hypertrophic cardiomyopathy (HCM). Which healthcare provider prescription will the nurse question? 1. Activity as tolerated 2. Administer atenolol daily 3. Give diltiazem daily 4. Consult cardiologist on call

1. The nurse would question unrestricted activity. Hypertrophic cardiomyopathy involves abnormal thickening of the heart muscle, particularly affecting the muscle of the heart's main pumping chamber (left ventricle). The thickened heart muscle can make it harder for the heart to pump blood. Restricting physical activity limits aggravating the heart. Atenolol and diltiazem are commonly used to control symptoms such as tachycardia and hypertension. A cardiologist would be consulted for treatment management.

The nurse caring for a client who had an anterior wall myocardial infarction (MI). During assessment, the nurse notes crackles in the client's lungs. What nursing action is priority? 1. Notify the healthcare provider. 2. Reassess the client in 1 hour. 3. Apply oxygen via nasal cannula. 4. Document the finding in the medical record.

1. The nurse would suspect the client is experiencing left-sided heart failure. The left ventricle is responsible for most of the cardiac output. An anterior wall MI may result in a decrease in left ventricular function. When the left ventricle does not function properly, resulting in left-sided heart failure, fluid accumulates in the interstitial and alveolar spaces in the lungs and causes crackles. The healthcare provider needs to be notified to confirm the nurse's suspicion. There are no indications the client needs oxygen therapy at this time. The nurse would assess respiratory rate and oxygen saturation level to determine if oxygen is needed. The nurse would document the finding and reassess the client; however, these are not priority as they provide no assistance to the client at this time.

The nurse identifies which intervention as priority for a client experiencing chest pain while walking? 1. Sitting the client down 2. Getting the client back to bed 3. Obtaining an electrocardiogram (ECG) 4. Administering sublingual nitroglycerin

1. The priority is to decrease the oxygen consumption; this would be achieved by sitting the client down. An ECG can be obtained after the client is sitting down. After the ECG, sublingual nitroglycerin would be administered. The client can return to bed once stabilized.

Which precaution will the nurse take when caring for a client with myocardial infarction who has received a thrombolytic agent? 1. Avoid puncture wounds. 2. Monitor potassium level. 3. Maintain a supine position. 4. Restrict fluid intake.

1. Thrombolytic agents are declotting agents that place the client at risk for hemorrhage from puncture wounds. All unnecessary needle sticks and invasive procedures should be avoided. The potassium level should be monitored in all cardiac clients, not just those receiving a thrombolytic agent. Although no specific position is required, most cardiac clients seem more comfortable in semi-Fowler's position. The client's fluid balance must be carefully monitored, but it is inappropriate to restrict fluid intake.

A client comes to the emergency department with symptoms of a myocardial infarction. The healthcare provider prescribes reteplase. The nurse will administer reteplase to the client at which time? 1. Within 3 hours of onset of symptoms 2. Within 6 hours of onset of symptoms 3. Within 8 hours of onset of symptoms 4. Within 12 hours of onset of symptoms

1. Thrombolytic agents such as reteplase can be given within 6 hours of the onset of symptoms but will be most effective when started within 3 hours.

A client is admitted with acute pulmonary edema. Which signs and symptoms will the nurse expect this client to exhibit? 1. Weight gain, abdominal distention, peripheral edema, jugular vein distention (JVD), tachycardia, and restlessness 2. Apprehension and restlessness, cough with frothy pink sputum, moist gurgling respirations with tachypnea, and orthopnea. 3. Exertional dyspnea, cough with mucopurulent sputum, prolonged expiration with wheezing and rackles, and orthopnea 4. Sharp chest pain that worsens on inspiration, dyspnea, cyanosis, light-headedness, and tachycardia

2. Apprehension, restlessness, frothy pink sputum, and moist breath sounds are typically findings in clients with acute pulmonary edema. Weight gain, edema, and JVD are signs and symptoms of right-sided heart failure. Exertional dyspnea and mucopurulent sputum are typical of emphysema. Chest pain that worsens with inspiration, dyspnea, cyanosis, light-headedness, and tachycardia are typical signs of acute pulmonary embolism.

The nurse is monitoring laboratory results for a client admitted with a possible myocardial infarction (MI). Which laboratory result will the nurse flag for the healthcare provider to review? 1. White blood cell (WBC) count 15,000 mm³ (15 ✕ 10⁹/L) 2. Troponin level less than 0.2 ng/mL (0.2 μg/L) 3. Red blood cell (RBC) count of 4.7 mm³ (4.7 ✕ 10¹²/L) 4. Mean corpuscular hemoglobin (MCH) of 27 pg/cell

2. Cardiac troponins are proteins that exist in cardiac muscle and are released with cardiac muscle injury. A troponin level of less than 0.2 ng/mL is considered normal and rules out an MI for this client. An elevated WBC count is seen in many disease processes and with severe necrosis but does not specifically indicate MI. An RBC count of 4.7 mm³ (4.7 ✕ 10¹²/L) is within normal limits for males and females but is not used to rule out an MI. MCH is an RBC index providing information about the hemoglobin concentration of RBCs and is not used to rule out an MI.

The nurse is assessing a client and observes jugular vein distention (JVD). The nurse will assess the client for which condition? 1. Abdominal aortic aneurysm 2. Heart failure 3. Myocardial infarction (MI) 4. Deep vein thrombosis.

2. Elevated venous pressure, exhibited as JVD, indicates the heart's failure to pump. This is not a symptom of abdominal aortic aneurysm or deep vein thrombosis. An MI, if severe enough, can progress to heart failure; however, in and of itself, an MI does not cause JVD.

A client is placed on epinephrine to stimulate the sympathetic nervous system. Which finding indicates to the nurse the client is responding appropriately to this medication? 1. Heart rate decreased from 78 to 56 beats/minute 2. Heart rate increased from 60 to 88 beats/minute 3. Blood pressure decreased from 120/80 to 100/56 mm Hg 4. Decrease of myocardial contractility

2. Epinephrine is a vasopressor, which belongs to a category of drugs called adrenergic drugs. Adrenergic drugs stimulate the sympathetic nervous system, causing tachycardia, increased blood pressure, vasoconstriction, and bronchodilation. This response causes an increase in contractility, which compensates for the response. The other symptoms listed are related to the parasympathetic nervous system, which is responsible for slowing the heart rate.

A client diagnosed with pulmonary edema is prescribed furosemide. Which statement made by the nurse is appropriate? 1. "Furosemide may cause hyperkalemia." 2. "Do not take with an aminoglycoside antibiotic." 3. "You should avoid eating bananas." 4. "If you develop a rash, apply topical diphenhydramine."

2. Furosemide may increase the ototoxic potential of aminoglycoside antibiotics and should be avoided. Furosemide can cause hypokalemia. Clients should eat foods high in potassium, such as spinach, yogurt, navy beans, and bananas, to limit the risk for hypokalemia. A rash could indicate a life-threatening complication and should be reported to the healthcare provider.

The nurse is educating a client with a blood pressure of 140/92 mm Hg on treatments. Which healthcare provider prescription will the nurse question? 1. Enalapril once daily 2. Limit physical activity 3. Limit alcohol and sodium intake 4. Decrease consumption of saturated fats

2. The nurse would question limiting physical activity for a client with hypertension. Treatments include weight reduction, exercise, dietary alterations, limiting alcohol intake, and ACE inhibitors.

A client is hospitalized to rule out an acute myocardial infarction (MI). Laboratory results are: lactate dehydrogenase (LDH) level 140 U/L (2.34 mkat/L) and troponin I level 0.5 ng/mL (0.5 mg/L). The nurse enters the client's room and finds the client pacing the floor. Which statement by the nurse is most appropriate in this situation? 1. "You had a heart attack. Get back in bed now." 2. "You seem upset. Let us sit and talk for a while." 3. "You sure have a lot of energy; do you want to play cards?" 4. "Your healthcare provider does not want you up. Please get into bed."

2. Given the laboratory data, especially the elevated troponin I level, the nurse should realize that the client probably had an MI and needs to lie down and rest the heart. However, the nurse should also realize the need to respond to the client's emotional distress by acknowledging the client's feelings and offering to discuss the situation. Stating the client had a heart attack would be giving a medical diagnosis that has not yet been made and would also be practicing outside the scope of nursing. A comment about the energy level acknowledges the client's pacing but not the underlying concerns. Stating the healthcare provider's preferences attempts to impose authority to control the client's behavior. It does not acknowledge the client's distress.

During a local wellness fair, the nurse assesses several clients' blood pressures. The nurse will refer which client for further evaluation for primary hypertension? 1. A 35-year-old pregnant woman with a blood pressure of 126/80 mm Hg 2. A 72-year-old woman with a blood pressure of 142/88 mm Hg 3. A 44-year-old man with end-stage renal failure and a blood pressure of 130/70 mm Hg 4. A 76-year-old man with a systolic blood pressure of 136 mm Hg

2. Hypertension is defined as a sustained systolic blood pressure of 140 mm Hg or a diastolic blood pressure of 90 mm Hg. Secondary hypertension is attributed to an identifiable medical diagnosis, such as gestational hypertension or renovascular disease. The 76-year-old man has prehypertension, which is defined as systolic blood pressure of 120 to 139 mm Hg or a diastolic pressure of 80 to 89 mm Hg.

The nurse is teaching a client newly diagnosed with hypertrophic cardiomyopathy (HCM). Which statement by the client best demonstrates an understanding of this disease process? 1. "I should participate in a vigorous aerobic exercise program to strengthen my heart function." 2. "Since this is a hereditary disorder, my family members should be evaluated for similar symptoms." 3. "Exercise or exertion could kill me. I should have a caretaker to perform my activities of daily living." 4. "I should keep a journal of my symptoms and take my prescribed medications only when I have symptoms."

2. Hypertrophic cardiomyopathy is a hereditary disease in which the heart muscle is abnormally thick and asymmetrical. In young clients, especially athletes, the first symptom may be sudden death during strenuous exercise. Strenuous physical exertion is restricted because it may precipitate arrhythmias or sudden cardiac death. The client is usually encouraged to perform normal activities of daily living after discussing restrictions with the healthcare provider. Medications, such as beta-blockers, calcium channel blockers, and antiarrhythmics, are usually prescribed and should be taken daily to help prevent complications.

A client arrives in the emergency department with tachycardia, decreased urination, restlessness, and confusion. Auscultation reveals a fourth heart sound. What does the nurse suspect is occurring? 1. Myocardial infarction 2. Cardiogenic shock 3. Peripheral vascular disease 4. Abdominal aortic aneurysm (AAA)

2. In cardiogenic shock, initially the nurse would see a decrease in cardiac output resulting in a decrease in cerebral blood flow, which causes restlessness, agitation, or confusion. Tachycardia, decreased urine output, and an S4 heart sound are all later signs of shock. Peripheral vascular disease, AAA, and MI do not have these same signs.

The nurse knows which client is at highest risk of developing an abdominal aortic aneurysm (AAA)? 1. A 54-year-old female client who has an infection of the aorta and a family history of heart failure 2. A 69-year-old male client who has smoked for 55 years and whose blood pressure is 144/92 mm Hg 3. A 75-year-old female client with new onset type 1 diabetes mellitus and a history of alcohol use disorder 4. A 60-year-old male client whose father died suddenly from a ruptured abdominal aortic aneurysm

2. Risk factors for AAA include age 65 and older, tobacco use, Caucasian ethnicity, male gender, family history, atherosclerosis, hypertension, and a history of large vessel aneurysms. Aorta infections are rarely associated with AAAs. A family history of heart failure, diabetes, and alcohol use disorder are not associated with AAAs.

Which statement made by a client who had a fasting lipoprotein profile indicates to the nurse that additional education is needed? 1. "Changing my diet has really helped lower my cholesterol. Now my LDL cholesterol level is 98 mg/dL (2.5 mmol/L)." 2. "My total cholesterol level is optimal. It used to be 350 mg/dL (9.1 mmol/L) and now it is 250 mg/dL (6.5 mmol/L)." 3. "My HDL cholesterol level is 60 mg/dL (1.6 mmol/L) so my risk for coronary heart disease is lower." 4. "Even though my lipoprotein profile is normal this year, I know I will need another one in 5 years."

2. The National Cholesterol Education Program classifies a total cholesterol of 240 mg/dL (6.2 mmol/L) or more as high, levels of 200 to 239 mg/dL (5.2 to 6.2 mmol/L) as borderline high, and levels less than 200 mg/dL (5.2 mmol/L) as desirable. LDL cholesterol levels of 100 mg/dL (2.6 mmol/L) or less and HDL cholesterol levels 60 mg/dL (1.6 mmol/L) or more are optimal. Adults should have a fasting lipoprotein profile performed every 5 years beginning at age 20.

Which factor does the nurse determine is most useful in detecting a client's risk of developing cardiogenic shock? 1. Monitoring the client's heart rate 2. Determining the client's cardiac index 3. Blood pressure fluctuations over the past month 4. Symptoms associated with decreased cerebral blood flow

2. The cardiac index, a figure derived by dividing the cardiac output by the client's body surface area, is used to identify whether the cardiac output is meeting a client's needs. Decreased cerebral blood flow, blood pressure, and heart rate are less useful in detecting the risk of cardiogenic shock.

Which characteristic will the nurse expect to see on a normal cardiac rhythm strip obtained from an adult client? 1. PR interval of greater than 0.24 second 2. Heart rate of 88 beats/minute 3. Two P waves preceding each QRS complex 4. QRS complexes greater than 0.16 second that vary in configuration

2. The normal adult heart rate is between 60 and 100 beats/minute. The normal PR interval is 0.12 to 0.20 second. In a normal cardiac cycle, there should be one P wave preceding each QRS complex. A normal QRS complex should be less than 0.10 second.

The nurse caring for a client whose cardiac monitor suddenly shows fibrillatory waves with no recognizable pattern. Which nursing intervention is priority? 1. Notify the healthcare provider. 2. Begin cardiopulmonary resuscitation (CPR). 3. Intubate the client. 4. Administer epinephrine.

2. The nurse would recognize the client was experiencing ventricular fibrillation (VF), which is the arrhythmia most commonly associated with sudden cardiac death. The nurse would begin CPR first. The nurse would notify the healthcare provider. If VF persisted, intubation, defibrillation, and medications would be initiated.

Which symptom(s) will the nurse report to the healthcare provider if assessed in a client diagnosed with left-sided heart failure? Select all that apply. 1. Syncope 2. Orthopnea 3. Jugular vein distention 4. Peripheral edema 5. S3 heart gallop 6. Ascites

3, 4, 6. The nurse would report unexpected findings to the healthcare provider. Jugular vein distention, peripheral edema, and ascites are expected in clients with right-sided heart failure. Right-sided heart failure often results from left-sided heart failure. When the left ventricle fails, increased pressure in the lungs can result in right-sided damage. Symptoms result when the right side no longer pumps effectively, leading to venous congestion. Left-sided heart failure causes decreased cardiac output and increases pulmonary congestion. Decreased cardiac output may cause a decrease in cerebral perfusion, resulting in syncope. Orthopnea is caused by pulmonary congestion. Development of an S3 gallop is caused by the left atria attempting to fill the distended left ventricle.

The nurse is monitoring a client with asthma taking atenolol. Which finding most concerns the nurse? 1. Baseline blood pressure 166/88 mm Hg; blood pressure 138/74 mm Hg after two doses of medication 2. Baseline resting heart rate 106 beats/minute; resting heart rate 88 beats/minute after two doses of medication 3. Development of audible expiratory wheezes the nurse can hear from anyplace in the client's room 4. A serum potassium level of 4.2 mEq/L (4.2 mmol/L) taken this morning prior to the start of the shift

3. Audible wheezing may indicate serious bronchospasms, especially in clients with asthma or obstructive pulmonary disease. Decreases in blood pressure and heart rate are expected outcomes when beta-blockers are administered. A serum potassium level of 4.2 mEq/L (4.2 mmol/L) is within normal limits.

The nurse is caring for a client with increased hydrostatic pressure and chronic venous stasis. The nurse will monitor this client for which condition? 1. Venous occlusion 2. Cool extremities 3. Nocturnal calf muscle cramps 4. Diminished blood supply to the feet

3. Calf muscle cramps result from increased pressure and venous stasis secondary to varicose veins. An occlusion is a blockage of blood flow. Cool extremities and dminished blood supply to the feet are symptoms of decreased arterial blood flow.

A client is newly diagnosed with hypertension of unknown origin. During assessment, the client's blood pressure is 152/94 mm Hg and the client is asymptomatic. How will the nurse document this condition? 1. Accelerated hypertension 2. Malignant hypertension 3. Primary hypertension 4. Secondary hypertension

3. Characterized by a progressive, usually asymptomatic blood pressure increase over several years, primary hypertension is the most common type. Malignant hypertension, also known as accelerated hypertension, is rapidly progressive and uncontrollable and causes a rapid onset of complications. Secondary hypertension occurs secondary to a known, potentially correctable cause.

The nurse is providing discharge education to a client diagnosed with unilateral, lower extremity deep vein thrombophlebitis (DVT). Which client statement indicates to the nurse additional discharge education is needed? 1. "I will elevate my legs when sitting and get up and walk around periodically." 2. "I need to take my warfarin exactly the way my healthcare provider prescribed it." 3. "If my compression hose roll down behind my knees, I will pull them up." 4. "I will contact my healthcare provider immediately if I have unusual bleeding."

3. Hose that roll down behind the knee indicates improperly fitting hose that will impede venous return and cause venous stasis. Support hose should be smooth from the toes to the end of the hose. Elevating the legs while sitting promotes venous return. Warfarin must be taken exactly as prescribed, and the client must monitor for potential bleeding.

The nurse reviews the medical record of a client who recently underwent an abdominal aortic aneurysm (AAA) resection. Which finding will the nurse expect in the client's medical record? 1. Cystic fibrosis 2. Lupus erythematosus 3. Marfan syndrome 4. Myocardial infarction (MI)

3. Marfan syndrome results in the degeneration of the elastic fibers of the aortic media. Therefore, clients with the syndrome are more likely to develop an aneurysm. Cystic fibrosis, lupus erythematosus, and MIs are not linked to AAAs.

The nurse is caring for a client newly diagnosed with coronary artery disease (CAD). Which prescription will the nurse anticipate the healthcare provider prescribing for this client? 1. Cardiac catheterization 2. Coronary artery bypass surgery 3. Lovastatin orally 4. Percutaneous transluminal coronary angioplasty (PTCA)

3. Oral medication administration is a noninvasive medical treatment for CAD and is usually the initial treatment for coronary artery disease. Antilipemic agents such as lovastatin are generally prescribed. Cardiac catheterization is not a treatment but rather a diagnostic tool. Coronary artery bypass surgery and PTCA are invasive, surgical treatments.

When a client experiences chest pain during an acute anginal episode, the nurse will expect to administer which form of nitroglycerin first? 1. Nitroglycerin IV drip at 10 mcg/minute 2. Application of 2 in (5 cm) of nitroglycerin paste to the chest wall 3. Metered buccal nitroglycerin spray, 0.4 mg/spray 4. Transdermal nitroglycerin patch, 0.2 mg/hour

3. Sublingual or buccal nitroglycerin is the route of choice to quickly reduce myocardial oxygen demand and dilate coronary arteries. IV nitroglycerin is usually begun after a trial of sublingual or buccal spray nitroglycerin has proved unsuccessful in relieving the client's symptoms. Nitroglycerin paste and transdermal patches may be administered later because they have slower actions.

The nurse is reviewing the diagnostic test results for a client with reports of chest pain. Which test result is most consistent with a diagnosis of angina? 1. Troponin level greater than 1.5 mg/mL 2. Creatine kinase isoenzymes (CK-MB) level of 45% 3. 12-lead electrocardiogram with abnormal T waves 4. Left ventricular ejection fraction of 30%

3. The 12-lead ECG with depressed, inverted, or downward slope to the T waves indicates ischemia. Elevated troponin and CK-MB levels indicate myocardial infarction, not ischemia. A decreased ejection fraction indicates heart failure.

A client treated for a myocardial infarction (MI) in the emergency room is admitted to the hospital. The nurse will complete which prescription first? 1. Give metolazone 2.5 mg daily. 2. Administer aspirin 160 mg daily. 3. Apply cardiac monitor. 4. Consult cardiac rehabilitation.

3. The nurse would first apply cardiac monitors to assess for arrhythmias. Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI. Metolazone and aspirin are long-term medications used to prevent another MI. Aspirin may be prescribed in conjunction with another antiplatelet medication; this is known as dual antiplatelet therapy (DAPT). Consulting cardiac rehabilitation assists a client to recover from an MI and is not priority.

The nurse is educating a client on the initial treatment goal of increasing myocardial oxygen supply for cardiogenic shock. The client demonstrates an understanding of this by making which statement? 1. "Increasing my oxygen will cause me to become acidotic." 2. "If I get less oxygen it will be easier on my body and I will get better quicker." 3. "If my body is in a shock state, it will actually need less oxygen." 4. "A balance must be maintained between oxygen supply and demand."

4. A balance must be maintained between oxygen supply and demand. In a shock state, the myocardium requires more oxygen. If it cannot get more oxygen, the shock worsens. Increasing the oxygen will also help correct metabolic acidosis and hypoxia. Infarction typically causes the shock state, so prevention is not an appropriate goal for this condition.

The nurse is admitting a client for suspected myocardial infarction (MI). The nurse will prepare the client for which laboratory test first? 1. Arterial blood gas (ABG) levels 2. Complete blood count (CBC) 3. Complete chemistry 4. Creatine kinase isoenzymes (CK-MB)

4. CK-MB isoenzymes are present in the blood after an MI. These enzymes spill into the plasma when cardiac tissue is damaged. ABG levels are obtained to review respiratory function, a CBC is obtained to review blood counts, and a complete chemistry is obtained to review electrolytes. Other testing may be indicated depending on the results of the CK-MB.

The nurse identifies which client to be at greatest risk for developing hypertension (HTN)? 1. A 45-year-old Caucasian woman who has diabetes mellitus and drinks a glass of wine once a month. 2. A 58-year-old Caucasian man who works in a factory and does not eat gluten or dairy products. 3. A 49-year-old woman of African decent who is moderately overweight and birthed four children. 4. A 52-year-old man of African decent who has a sedentary lifestyle and drinks beer daily.

4. Clients of African decent are two to three times more likely to develop hypertension than Caucasian clients. Men are more likely to have HTN than women until age 65. The older a person is, the more likely the person is to be diagnosed with HTN. Modifiable risk factors include sedentary lifestyle, poor diet high in sodium, overweight/obse, excessive alcohol consumption, hypercholeserolemia, diabetes, stress, sleep apnea, and smoking/tobacco use. Consuming a glass of wine monthly is not excessive; however, daily consumption of beer is. Factory work, a diet free of gluten and dairy, and parity are not related to HTN.

The nurse is obtaining a health history from a client who has just been diagnosed with coronary artery disease (CAD). Which finding(s) will the nurse report immediately to the healthcare provider? Select all that apply. 1. Normal findings during asymptomatic progression 2. Chest pain 3. Palpitations 4. Confusion 5. Syncope 6. Excessive fatigue

4. Confusion is associated with decreased blood flow to the brain, not the heart. This finding is not expected and should be immediately reported to the healthcare provider. Symptoms of CAD occur when the artery is occluded to the point that inadequate blood supply to the cardiac muscle occurs. Assessment findings include: potential normal findings during asymptomatic progression, chest pain, palpitations, syncope, and excessive fatigue.

A client recently had a myocardial infarction (MI). Which finding does the nurse identify to be a normal metabolic change occurring after an MI? 1. Slowing of impulses through the atrioventricular (AV) node 2. Increased platelet aggregation 3. Decreased left ventricular ejection fraction 4. Increased serum glucose and free fatty acid protein levels

4. Glucose and fatty acids are metabolites whose levels increase after an MI. Slow conduction of impulses through the AV node is an electrophysiological change. Hematologic changes affect the blood cells and platelets. Ejection fraction measures the mechanical pumping action of the heart.

A client is experiencing chest pain at rest that is unresponsive to nitroglycerin. The healthcare provider diagnoses unstable angina and prescribes immediate surgical intervention. For which treatment will the nurse prepare the client. 1. Cardiac catheterization 2. Echocardiogram 3. Heart transplantation 4. Percutaneous transluminal coronary angioplasty (PTCA)

4. PTCA can alleviate the blockage and restore blood flow and oxygenation. An echocardiogram is a noninvasive diagnostic test. Heart transplantation involves replacing the client's heart with a donor heart and is the treatment for end-stage cardiac disease. Cardiac catheterization is a diagnostic tool, not a treatment.

The nurse notes dependent edema, weight gain, shortness of breath, and jugular vein distention (JVD) while assessing a 62-year-old client. The client's brain natriuretic peptide (BNP) level is 950 pg/mL (950 ng/L). Which nursing intervention is priority? 1. Administer furosemide IV. 2. Complete chest x-ray as prescribed. 3. Notify the healthcare provider. 4. Apply oxygen to the client.

4. The nurse would first apply oxygen to the client having shortness of breath. The BNP level indicates unstable heart failure (>900 pg/mL [>900 ng/L] in clients age 50 or older); therefore, the nurse would notify the healthcare provider. Dependent edema, weight gain, and JVD are secondary effects of right-sided heart failure. A chest x-ray may be done to assess for pulmonary congestion. Furosemide would be given to promote fluid excretion.

The nurse is discharging a client diagnosed with hypertension after having a myocardial infarction (MI). The nurse will question which prescription? 1. Metolazone 2. Metolazone 3. Losartan 4. Amiodarone

4. The nurse would question amiodarone being prescribed for this client. Antiarrhythmics such as amiodarone are used to treat life-threatening recurrent ventricular fibrillation and hemodynamically unstable tachycardia. Beta-blockers, such as metoprolol, work by decreasing catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing the heart's workload. Thiazide diuretics, such as metolazone, work by limiting the body's ability to absorb sodium, resulting in fluid excretion. Angiotensin II receptor blockers, such as losartan, work by reducing the effect of angiotensin II in the body. This results in vasodilation, which lowers blood pressure.

The nurse is administering digoxin to a client with pulmonary edema. Which finding will cause the nurse to hold the medication? 1. The client states, "I feel very sleepy." 2. The client's pulse is 69 beats/minute. 3. Urine output is 940 mL over the past 24 hours. 4. Digoxin level is 3.5 ng/mL (4.48 nmol/L).

4. The nurse would withhold digoxin for a serum level of 3.5 ng/mL (4.48 nmol/L). Therapeutic digoxin levels range from 0.5 to 2 ng/mL (0.64 to 2.56 nmol/L). Feeling sleepy is not an indication to hold digoxin. The pulse rate and urine output are both within normal limits.

The telemetry monitor technician notifies the nurse a client has sinus bradycardia with a heart rate of 42 beats/minute. What is the priority nursing intervention? 1. Administer a calcium channel blocker. 2. Obtain a 12-lead electrocardiogram (ECG). 3. Notify the client's healthcare provider. 4. Check the client's level of consciousness (LOC) and vital signs.

4. The priority is to assess the client's LOC, obtain vital signs, and determine the presence or absence of symptoms. Administering a calcium channel blocker and calling the healthcare provider are not priorities. Obtaining a 12-lead ECG may be necessary but is not the priority.

A client is admitted to the emergency department with a pulsating sensation in the abdomen and an audible bruit. Which test will the nurse expect to prepare the client for first? 1. Abdominal x-ray 2. Arteriogram 3. Computed tomography (CT) scan 4. Ultrasound

4. Ultrasound is a noninvasive, cost-effective method of determining the presence of an abdominal aortic aneurysm (AAA) with 95% accuracy. Arteriograms and CT scans are more expensivem, require the use of contrast agents and radiation, and are riskier to the client. An AAA would only be visible on an x-ray if it were calcified.

A client is diagnosed with a ruptured aortic aneruysm. Which nursing action is appropriate? 1. Give captopril orally. 2. Transport the client for an aortogram. 3. Administration propranolol. 4. Prepare the client for surgery.

4. When the vessel ruptures, surgery is the only intervention that can repair it. Administration of angiotensin-converting enzyme (ACE) inhibitors and beta-blockers can help control hypertension, reducing the risk of rupture. An aortogram is a diagnostic tool used to detect an aneurysm.