Ch 19 & 20

Which teaching point will the nurse include when providing discharge instructions to the patient with a new permanent pacemaker?

"Avoid lifting heavy objects for as long as your physician prescribes"

The nurse caring for a patient who requires a temporary transvenous pacemaker. Which statement indicates that the patient understands the nurse's teaching?

"I may experience uncomfortable muscle contractions"

The nurse is caring for a post-MI patient who has been started on daily simvastatin (Zocor) and a low-fat diet. Which statement best indicates that the nurse's teaching has been successful?

"I should call my doctor if I experience unexplained muscle pain"

The nurse is teaching the patient with an arrhythmia. Which statement indicates that the patient requires further teaching?

"I've switched from 5 cups of coffee to 5 cups of tea"

The nurse clarifies that the MONA protocol for drug administration in the emergent stage of a MI involves the use of which therapies? (select all)

-aspirin -morphine -nitrates -oxygen

The nurse is explaining the difference between exertional angina and unstable angina. Which statement about unstable angina is accurate?

unstable angina occurs unpredictably, even in sleep

Which disorganized ECG pattern is recognized as the most fatal of all arrhythmias?

ventricular fibrillation

The nurse is caring for a patient with a history of left-sided congestive heart failure(CHF). Which finding leads the nurse to suspect that the patient could be experiencing an acute exacerbation of this condition?

wheezes are present during lung auscultation

The drug alteplase (t-PA) is given to the patient with a MI. Which statement accurately describes the purpose of this medication?

"Alteplase (t-PA) dissolves the obstruction in the coronary artery"

The nurse is caring for a patient with severe congestive heart failure (CHF) who denies pain and is fearful of taking prescribed morphine. Which explanation best works to alleviate the patient's anxiety about risk of addiction?

"Morphine has properties that help relieve air hunger in CHF patients"

The statement indicates that the nurse's teaching about the purpose of an implanted cardioverted-defibrillator (ICD) has been successful?

"The ICD will detect bad rhythms and shock my heart into normal rhythm"

The 60 year old female in the post-coronary care unit confides to the nurse, "My life is over. I'll never be able to care for my family, take a vacation, or work in my garden." Which response is most supportive?

"You sound a little down. Tell me what you think is going to keep you from those activities; we might be able to address the problems"

The patient states that he has a cardiac catheterization 10 years ago and wonders if any of the postprocedure care has changed. Which response by the nurse is most accurate?

"You will most likely be able to ambulate within a few hours if your doctor uses an arterial closure device at the catheter insertion site"

The patient being evaluated for a heart transplant asks the nurse what the survival rate is. Which response is best for the nurse to make?

"every patient has different circumstances, but the average 5 year survival rate is 79%"

The nurse performs patient teaching about minimally invasive direct coronary artery bypass (MIDCAB). Which statement indicates that the patient needs further instruction?

"it frightens me to think that my heart will be stopped for a long time during surgery"

The nurse is educating a patient on a low-fat, low-cholesterol diet after an MI. Which food choice should the nurse recommend?

"replace a serving of red meat with a serving of fish"

The nurse is caring for a post-MI patient. The patient questions the reason for a stool softener and denies constipation. Which statement indicates that the patient accurately understands the nurse's teaching?

"stool softeners help me keep from straining during bowel movements, which can lower my heart rate"

The nurse is aware that a positive diagnosis of a MI is based on which diagnostic test findings? (select all)

-ECG changes in the QRS complex -elevation of troponin levels

The nurse instructs a patient that the pain of angina is due to ischemia of the myocardium. Which factors are causative agents for angina? (select all)

-exertion -emotional excitement -eating heavy meals -exposure to cold

Which herbs and supplements lower cholesterol? (select all)

-garlic -oatmeal -soy products

Which factors are potential causative agents for arrhythmias? (select all)

-hyperkalemia -valvular prolapse -infarct damage -excess fluid

The nurse is caring for a 60 year old African American patient with hypertension. The patient is obese and a smoker. Which modifiable risk factors place this patient at an increased risk for heart disease? (select all)

-hypertension -obesity -smoking

The nurse in a skilled nursing facility is caring for an 80 year old patient who develops a productive cough with pink, frothy sputum. Which independent interventions should the nurse implement immediately? (select all)

-limit the patient's activity -place the patient in high fowler position

The nurse encourages the patient who has had a MI to enroll in the outpatient cardiac rehabilitation in order to receive which services? (select all)

-nutritional counseling -supervised progressive exercise -stress reduction techniques

Which statements accurately describes characteristics of normal sinus rhythm (NSR)? (select all)

-one atrial contraction (P wave) -one ventricular contraction (QRS complex) -one T wave -heart rate 60-100

The nurse is caring for a 38 year old African American patient with diabetes. The patient manages her diabetes with dietary control, takes oral contraceptives, and is a nonsmoker. Which characteristics in the patient's history increase the patient's risk for coronary artery disease (CAD)? (select all)

-race -diabetes -use of oral contraceptives

The nurse is performing an initial assessment on a new patient with suspected right-sided heart failure. Which findings are consistent with the patient's potential diagnosis? (select all)

-splenomegaly -abdominal distention -dyspnea

Place the events of arterial obstruction in proper sequence.

-streaks of fatty material are laid down in arteries -deposits of LDLs accumulate -fibrous plaque is laid down in vessel -platelets adhere to plaque -platelets clump -platelets calcify

The nurse is educating a patient about cardiomyopathy. The nurse includes information that which circumstances may increase risk for cardiomyopathy? (select all)

-systemic hypertension -chronic excessive alcohol consumption -pregnancy -systemic infection

During the acute phase following a MI, the nurse anticipates that the patient may require a temporary pacemaker in which situations? (select all)

-the patient experiences complete heart block -the patient's pulse rate remains below 40 beats/min

The nurse is caring for several patients on a cardiac care unit. Which patient is most likely to have aortic stenosis?

86 year old with a history of atherosclerosis

The nurse is caring for a patient with atrial fibrillation who asks why she needs to take warfarin. Which statement best answers the patient's question?

Warfarin prevents clots from forming in the atria

The home health care nurse is caring for a patient with CHF. Which assessment finding should the nurse report immediately to the physician?

a 3 pound weight gain over the course of a week

Which potential hazard is most important for a patient with an automatic implantable cardioverter-defibrillator (AICD) to avoid?

airport security detection devices

The nurse is caring for a patient with congestive heart failure (CHF). Which intervention should the nurse include in the plan of care?

alternate with rest activity

How does a myocardial infarction alter the pumping efficiency of the heart?

an MI causes myocardial necrosis

The nurse is analyzing a patient's telemetry strip and observes a sawtooth appearance with no P waves. How should the nurse document this finding?

atrial flutter

The nurse is caring for a patient who is taking digitalis. The patient complains of increased thirst, and the nurse observes dry mucous membranes. Which additional finding warrants the nurse's immediate attention?

blurred vision

When the nurse assesses an apical pulse of 52, the nurse documents this arrhythmia as _____________.

bradycardia

The nurse is caring for a patient with a heart rate of 115 beats/min and complaints of shortness of breath. The nurse anticipates that these findings are most likely related to which underlying problem?

decreased cardiac output

The nurse is caring for a patient with suspected right-sided heart failure. Which manifestation best supports this potential diagnosis?

edema

The nurse is caring for a patient who underwent a transfemoral cardiac catheterization with coronary angiography earlier in the day. The patient denies pain and no longer requires bed rest. The groin is soft with no palpable hematoma. Which postprocedure care is most important for the patient at this time?

encourage increased fluid intake

The nurse is caring for a female patient with a family history of heart disease who is undergoing a workup for cardiovascular disease. Which finding is most concerning to the nurse?

fatigue

The nurse expresses concern to the 80 year old resident in a long-term care facility who is attempting to jog on a treadmill. The nurse is aware that the exceptional oxygen and metabolic demands brought on by the exercise might cause ____________.

heart failure

The nurse caring for a patient who is taking amiodarone (Cordarone). What side effect could this patient experience?

hypotension

The nurse is caring for a patient with angina pectoris who asks what happens to make his body experience pain. The nurse explains that pain results from which underlying causative factor?

inadequate blood flow and poor oxygen blood supply

The nurse uses a diagram to show how obstruction of an artery has caused an area of necrosis called an ___________.

infarction

The patient with angina asks the nurse how a daily dose of 81 mg of aspirin is helpful. Which reply is best?

low-dose aspirin helps reduce clotting

The nurse is aware that the patient's cardiac rehabilitation levels of physical activity are designated through _______ units.

metabolic equivalent

A patient who presented to the emergency room with a MI becomes pale, diaphoretic, and hypotensive. What action should the nurse take first?

notify the physician immediately

The nurse assessed a friction rub in a patient who is 2 days post-MI. The nurse recognizes this finding indicates which problem?

pericarditis

The patient suffering from ventricular tachydysrhythmia may benefit from ____________ when medications are not effectively treating the disorder.

radiofrequency catheter ablation

The nurse is caring for a male patient with angina who has a new prescription for sublingual nitroglycerin. What information is most important for the nurse to include in the teaching plan?

store nitroglycerin tablets in a cool, dark location

Which statement accurately explains how calcium channel blocker verapamil assists to correct an arrhythmia?

the medication inhibits transmission of the impulse from the AV node

The nurse is caring for a patient admitted with chest pain to rule out a MI. The nurse observes that the patient is experiencing ECG changes and reviews new laboratory results. Which lab value should the nurse report immediately?

troponin of 2.4 mcg/L

The nurse is caring for a patient with uncontrolled hypertension, diabetes, asthma, and GERD. Which problem serves as a contraindication for a thrombolytic agent?

uncontrolled hypertension