CHA1 Exam 4 - Cardiac

afterload

the peripheral resistance against which the left ventricle must pump (aka PRESSURE) **use of wide mouth bucket vs. bucket with a funnel on top**

Bradycardia treatment

treat only if client is symptomatic Medication: atropine and isoproterenol Electrical management: pacemaker

When calcium is < 9.0

ventricular dysrhythmias cardiac arrest

When are cardiac enzymes released into the bloodstream?

when the heart muscle suffers ischemia

ischemia

restriction in blood supply to tissues, causing a shortage of oxygen that's needed for cellular metabolism

dilitiazem

calcium channel blocker

drugs used for v tach and pvc's

lidocaine

A nurse is caring for a client who has a deep vein thrombosis and is prescribed heparin by continuous IV infusion at 1,200 units/hr. Available is heparin 25,000 units in 500 mL D5W. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest tenth/whole number. Use a leading zero if it applies. Do not use a trailing zero.) ______ mL/hr

1,200 units x 500 mL/25,000 units Essentially: (1,200 units x 500 mL)/25,000 units = 24 mL/hr

CK-MB - cardiac enzyme

30-170 units/L Elevated levels first detectable at: 4-6 hrs post injury Elevated levels last how long: 3 days indicates tissue necrosis

Troponin - cardiac enzyme

<0.2 ng/L Elevated levels first detectable at: 3-5 hrs post injurty Elevated levels last how long: 7-21 days myocardial muscle protein - seen earlier but specific

Triglycerides

<150 mg/dL Evaluating test for atherosclerosis

Cholesterol (total)

<200 mg/dL screening test for heart disease and CAD

Myoglobin - cardiac enzyme

<90 mcg/L Elevated levels first detectable at: 2 hrs post ANY injury Elevated levels last how long: 24 hrs myocardial muscle protein - early marker

When calcium is > 10.5

A-V block dig hypersensitivity cardiac arrest

Electrocardiography

EKG Limb leads - 12 lead provides the best picture Telemetry - 5/6 lead *MOST COMMON is Lead 2* Each lead gives a different angle of the heart

Chest pain management: M_______ O_____ N____________ A______

Morphine Oxygen Nitroglycerin Aspirin

When potassium is < 3.5

electrical instability ventricular dysrhythmias high risk of dig toxicity PVC's

How is ventricular fibrillation seen on a strip?

no visible P wave unmeasurable HR, PR interval, and QRS rhythm is irregular and chaotic

Normal and therapeutic range for activated partial thromboplastin time (aPTT)

normal: 25-35 therapeutic: 46-70 greater than/equal to 90: PROBLEM

Diagnostic testing

Electrocardiography Electrophysiologic study Exercise electrocardiography Echocardiography Imaging

verapamil

calcium channel blocker

C- reactive protein

indicates inflammation (atherosclerosis)

LDL (lethal)

<130 mg/dL "Bad" cholesterol can be up to 70% of total cholesterol test for CAD

HDL (healthy)

F: 35-80 mg/dL M: 35-65 mg/dL "Good" cholesterol produced by liver

Atrial fibrillation, supraventricular tachycardia, or ventricular tachycardia with pulse treatment

Medication: amiodarone, adenosine, verapamil Electrical management: synchronized cardioversion

Ventricular tachycardia without pulse or ventricular fibrillation treatment

Medication: amiodarone, lidocaine, and epinephrine Electrical management: defirbrillation

sinus tachycardia

SA node discharge exceeds 100 bpm normal P wave use valsulva maneuver

atenolol (Tenormin)

beta-adrenergic blocker

Name four modifiable risk factors to acute coronary syndrome

elevated serum cholesterol cigarette smoking hypertension impaired glucose tolerance - diabetes (prevent and control hyperglycemia) obesity diet physical inactivity stress

Holter monitoring

evaluation of dysrhythmias cell phone systems

drugs used for a-fib/flutter, svt's, and v tach

quinidine - anticholinergic

State the normal values for the following segments/intervals when measuring EKGs or telemetry: - PR interval - QRS duration - QT interval

PR interval: 0.12-0.20 seconds QRS duration: 0.04-0.12 seconds QT interval: 0.34-0.43 seconds

Cardiac output, the volume of blood ejected by the heart per minute, is calculated by doing which mathematical equation?

heart rate (HR) x stroke volume (SV) = cardiac output (CO)

Identifying details of Supraventricular Tachycardia

rapid stimulation of atrial tissue that occurs at a rate of 100-280 bpm, with a mean of 170 bpm in adults

Identifying details of Ventricular Tachycardia (V tach)

repetitive firing of an irritable ectopic focus, usually at a rate of 140-180 bpm

sinus bradycardia

sinus node discharge < 60 bpm... asymptomatic until < 50 pacemaker ATROPINE put on O2

How is sinus tachycardia seen on a strip?

sinus rate above 100 bpm normal P waves

When potassium is > 5.3

slowed conduction cardiac standstill

cardiac output

HR x SV amount of blood pumped by each ventricle in one minute **the fluid, which was transferred to the 2nd bucket via the sponge**

The nurse is caring for a patient newly diagnosed with heart failure. The patient is to receive a first dose of digoxin 0.125 mg IV push. An ampule containing 0.25 mg/mL is available. Calculate the number of milliliters the nurse should draw up to administer this dose. _____ mL

0.5 mL dose desired / dose available = answer

How is ventricular tachycardia seen on a strip?

3 or more premature ventricular contractions that have distorted QRS complexes regular or irregular rhythm P wave usually buried in QRS complex no measurable PR interval

A patient has been diagnosed with early left ventricular heart failure (HF). The nurse knows that the following changes occur as the disease progresses. In which order do the changes involved in the development of dyspnea associated with left ventricular HF occur? ___,___,___,___ a. Inadequate alveolar gas exchange b. Elevated pressure in the left atrium c. Ineffective ventricular contractility d. Fluid leaking into interstitial spaces

C, B, D, A if contractility continues to falter, the blood continues to back up into the pulmonary vasulature and eventually can result in fluid leaking into the interstitial spaces and alveoli of the lungs

The patient's blood pressure is 90/50 mmHg. The nurse calculates the mean arterial pressure (MAP) to see if the blood pressure is high enough to adequately perfuse and sustain the vital organs. What is the MAP? _________

MAP: 63 90 + 2(50) / 3 = 63 MAP greater than 60 is needed to perfuse blood to brain and vital organs

A nurse is teaching a client who takes warfarin daily. Which of the following statements by the client indicates a need for further teaching? a. "I have started taking ginger root to treat my joint stiffness." b. "I take this medication at the same time each day." c. "I eat a green salad every night with dinner." d. "I had my INR checked three weeks ago."

a. "I have started taking ginger root to treat my joint stiffness." remember the 4 G's/supplements that interfere with warfarin: Ginger, Garlic, Ginkgo biloba, and Ginseng. b is incorrect because it's good they're taking it routinely c is incorrect because they're eating the green salad consistently, as opposed to randomly. still important to watch vitamin K though d is incorrect because INR should be checked every 2-4 weeks, so the patient did the right thing.

A nurse is teaching the partner of a client who had an acute myocardial infarction (MI) about the reason blood was drawn from the client. Which of the following statements should the nurse make regarding cardiac enzymes studies? a. "These tests help determine the degree of damage to the heart tissues." b. "Cardiac enzymes will identify the location of the MI." c. "These tests will enable the provider to determine the heart structure and mobility of the heart valves." d. "Cardiac enzymes assist in diagnosing the presence of pulmonary congestion."

a. "These tests help determine the degree of damage to the heart tissues." Troponin can show cardiac muscle death In b, cardiac enzymes should be replaced with EKG to be correct. In c, it's describing an ECHO. in d, it's describing a chest x-ray.

A nurse is assessing an older adult client who is receiving digoxin. The nurse should recognize that which of the following findings is a manifestation of digoxin toxicity? a. Anorexia b. Ataxia c. Photosensitivity d. Jaundice

a. Anorexia a is one of the earliest signs of dig toxicity, along with N/V. Green/yellow halos are seen later with vision changes like blurred vision Digoxin helps with contractility and rhythm

When checking a client's capillary refill, the nurse finds that the color returns in 10 seconds. The nurse should understand that this finding indicates which of the following? a. Arterial insufficiency b. Venous insufficiency c. Within the expected range d. Thrombus formation in the vein

a. Arterial insufficiency a is correct, patients have poorer circulation to the extremities b is incorrect, in venous insufficiency, the blood has a hard time getting back to the heart c is incorrect, expected range of capillary refill is 3-5 seconds d is incorrect, not seen in arterial insufficiency

Propranolol (Inderal) is contraindicated for a client who has which of the following conditions? a. Asthma b. Diabetes c. Angina d. Dementia

a. Asthma Propranolol is a non-selective beta-adrenergic blocker and blocks both beta1 and beta2 receptors. Blockade of beta2 receptors in the lungs causes bronchoconstriction, so it is contraindicated in clients with asthma. Use propranolol cautiously with clients who have diabetes, but it is not contraindicated. Propranolol can be used to treat angina. It is not contraindicated in dementia.

The nurse is caring for a patient admitted with chronic obstructive pulmonary disease (COPD), angina, and hypertension. Before administering the prescribed daily dose of atenolol 100 mg PO, the nurse assesses the patient carefully. Which adverse effect is this patient at risk for given the patient's health history? a. Bronchospasm b. Hypocapnia c. N/V d. Tachycardia

a. Bronchospasm atenolol is a cardioselective b1-adrenergic blocker that reduces BP and could affect the b2-receptors in the lungs with larger doses or drug accumulation

A nurse is caring for a client who develops a ventricular fibrillation rhythm. The client is unresponsive, pulseless, and apneic. Which of the following actions is the nurse's priority? a. Defibrillation b. Airway management c. Epinephrine administration d. Amiodarone administration

a. Defibrillation a is correct, the patient is basically dead b is incorrect, you need to revive them first, then manage their airway when they're actually breathing c is incorrect, it's used in ACLS but not when the patient is dead d is incorrect, amiodarone is used in v-tach

The nurse is providing teaching to a patient recovering from a myocardial infarction. How should resumption of sexual activity be discussed? a. Discussed along with other physical activities b. Avoided because it's embarrassing to the patient c. Delegated to the primary care provider d. Accomplished by providing the patient with written material

a. Discussed along with other physical activities It is a necessary component of patient teaching and should be included

The nurse observes a flat line on the patient's monitor and the patient is unresponsive without pulse. What medications does the nurse prepare to administer? a. Epinephrine and/or vasopressin b. Digoxin and procainamide c. B-adrenergic blockers and dopamine d. Lidocaine and amiodarone

a. Epinephrine and/or vasopressin May prompt the return of depolarization and ventricular contraction

A nurse is caring for an older adult client who has left-sided heart failure. Which of the following assessment findings should the nurse expect? a. Frothy sputum b. Dependent edema c. Nocturnal polyuria d. Jugular distention

a. Frothy sputum b, c, and d are all signs of right-sided heart failure

The nurse observes ventricular tachycardia on the patient's monitor. What evaluation made by the nurse led to this interpretation? a. HR 200 bpm, P wave not visible b. HR 125 bpm, normal QRS complex c. HR 150 bpm, inverted P wave d. Unmeasureable rate and rhythm

a. HR 200 bpm, P wave not visible VT is associated with HR 150-250 bpm, P wave normally not visible Rate and rhythm are immeasurable

A nurse is caring for a client 4 hr following a cardiac catheterization. Which of the following actions should the nurse take? a. Have the client lie flat in bed b. Keep the affected leg slightly flexed c. Elevate the HOB 45 degrees d. Keep the client NPO for 4 hr

a. Have the client lie flat in bed a is correct because if they performed the cardiac catheterization via the femoral approach, they'd need to lie flat in bed for some time b is incorrect because the affected leg should remain straight c is incorrect because the HOB should be less than or equal to 30 degrees raised d is incorrect because the nurse should push fluids to flush the dye out of the patient's system and keep the kidneys functioning

The nurse teaches a patient with hypertension that uncontrolled hypertension may damage organs in the body PRIMARILY by which mechanism? a. HTN promotes atherosclerosis and damage to the walls of the arteries b. HTN increases blood viscosity, which contributes to the intravascular coagulation and tissue necrosis distal to occlusions c. HTN causes direct pressure on organs, resulting in necrosis and replacement of cells with scar tissue d. HTN causes thickening of the capillary membranes, leading to hypoxia of organ systems

a. Hypertension promotes atherosclerosis and damage to the walls of the arteries HTN is major risk factor for atherosclerosis

What should the nurse recognize as an indication for the use of dopamine in the care of a patient with heart failure? a. Hypotension and tachycardia b. Peripheral edema and weight gain c. Paroxysmal nocturnal dyspnea (PND) d. Acute anxiety

a. Hypotension and tachycardia Dopamine is a b-adrenergic agonist whose inotropic action is used for the treatment of severe HF accompanied by hemodynamic instability, sucha a state may be indicated by tachycardia accompanied by hypotension

A nurse is assessing a client who has fluid overload. Which of the following findings should the nurse expect? a. Increased heart rate b. Increased blood pressure c. Increased respiratory rate d. Increased hematocrit e. Increased temperature

a. Increased heart rate b. Increased blood pressure c. Increased respiratory rate d is incorrect, hematocrit would decrease also seen in fluid overload: extracellular fluid in interstitial and vascular spaces, crackles, edema

The nurse is teaching a women's group about prevention of hypertension. What information should be included in the teaching for all the women? Select all that apply. a. Limit sodium and fat intake b. Increase fruits and vegetables c. Limit nuts and seeds d. Exercise 30 minutes most days e. Lose weight

a. Limit sodium and fat intake b. Increase fruits and vegetables d. Exercise 30 minutes most days primary prevention of HTN is to make lifestyle modifications: exercise 30 min most days, DASH diet, increase fruit and veggies. Weight loss isn't always necessary and nuts/seeds contribute to protein

A patient admitted with heart failure is anxious and reports SOB. Which nursing actions would be appropriate to alleviate this patient's anxiety? Select all that apply. a. Position patient in a semi-Fowler's position b. Use a calm, reassuring approach while talking to the patient c. Administer ordered morphine sulfate d. Instruct patient on the use of relaxation techniques e. Position patient on left side with HOB flat

a. Position patient in a semi-Fowler's position b. Use a calm, reassuring approach while talking to the patient c. Administer ordered morphine sulfate d. Instruct patient on use of relaxation techniques morphine reduces anxiety and may assist in reducing dyspnea. semi-fowlers improves ventilation

A nurse is caring for a patient immediatelhy following a transesophageal echocardiogram (TEE). Which assessments are appropriate for this patient? Select all that apply. a. Position patient supine with HOB flat b. Monitor vital signs and oxygen saturation c. Assess lower extremities for circulatory compromise d. Assess for return of gag reflex e. Assess groin for hematoma or bleeding

a. Position patient supine with HOB flat c. Assess lower extremities for circulatory compromise d. Assess for return of gag reflex Sedation is usually a throat-numbing spray. Vital signs and o2 saturation are important because of sedation used.

The patient has heart failure (HF) with an ejection fraction of less than 40%. What core measures should the nurse expect to include in the plan of care for this patient? Select all that apply. a. Prescription for angiotensin-converting enzyme inhibitor at discharge b. Prescription for digoxin (Lanoxin) at discharge c. Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen d. Left ventricular funciton is documented e. Controlling dysrhythmias will eliminate HF

a. Prescription for angiotensin-converting enzyme inhibitor at discharge c. Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen d. Left ventricular function is documented These are the 3 core measures identified by TJC

When teaching a patient about dietary management of stage 1 hypertension, which instruction is MOST appropriate? a. Restrict sodium intake b. Increase water intake c. Use calcium supplements d. Increase protein intake

a. Restrict sodium intake

The nurse would assess a patient with complaints of chest pain for which clinical manifestation associated with myocardial infarction? Select all that apply. a. S3 or S4 heart sounds b. N/V c. Flushing d. Diaphoresis e. Ashen skin

a. S3 or S4 heart sounds b. N/V d. Diaphoresis e. Ashen skin catecholamines released from injured myocardial cells increase the sympathetic nervous system stimulation.

A nurse is assessing a client who is taking chlorothiazide sodium. The nurse recognizes which of the following as a manifestation of hypokalemia? a. Shallow respirations b. Hypertensive crisis c. Diarrhea d. Hyperreflexia

a. Shallow respirations when potassium is LOW, the client should be more drowsy, when the potassium is HIGH, the client will be more hyperactive. more s/s of hypokalemia: constipation, confusion, weakness, bradycardia

The nurse is performing an assessment for a patient undergoing radiation treatment for breast cancer. What position should the nurse place the patient to BEST auscultate for signs of acute pericarditis? a. Sitting and leaning forward b. Left lateral side-lying position c. HOB at a 45 degree angle d. Supine without a pillow

a. Sitting and leaning forward To auscultate a friction rub, they should be sitting like this and the nurse will hear it at the end of expiration

A 67 yo woman with hypertension is admitted to the emergency department with a BP of 234/148 mmHg and was started on nitroprusside (Nitropress). After one hour of treatment, the mean arterial blood pressure (MAP) is 55 mmHg. Which nursing action is a PRIORITY? a. Stop the nitroprusside infusion and assess the patient for potential complications b. Maintain the current administration rate of the nitroprusside c. Start an infusion of 0.9% NS at 100 mL/hr d. Request insertion of an arterial line for accurate blood pressure monitoring

a. Stop the nitroprusside infusion and assess the patient for potential complications nitroprusside is a potent vasodilator medication and could cause a stroke, MI, or renal failure if BP is dropped too quickly

When caring for elderly patients with hypertension, which information should the nurse consider when planning care? Select all that apply. a. Systolic blood pressure increases with age b. Older patient will require higher does of antihypertensive medications c. Volume depletion contributes to orthostatic hypotension d. White coat syndrome is prevalent in elderly patients e. Blood pressures should be maintained near 120/80 mmHg f. Blood pressure drops 1 hour postprandially in many older patients

a. Systolic blood pressure increases with age c. Volume depletion contributes to orthostatic hypotension d. White coat syndrome is prevalent in elderly patients f. Blood pressure drops 1 hour postprandially in many older patients

A patient with aortic valve stenosis is being admitted for valve replacement surgery. Which assessment finding documented by the nurse is indicative of this condition? a. Systolic murmur b. Distended neck veins c. Splinter hemorrhages d. Pulse deficit

a. Systolic murmur The turbulent blood flow across a diseased valve results in a murmur, aortic stenosis produces a systolic murmur

What is the PRIORITY nursing intervention in the care of a patient with a diagnosis of chronic venous insufficiency (CVI)? a. Teaching the patient the correct use of compression stockings b. Administration of oral and/org subcutaneous anticoagulants c. Application of topical antibiotics to venous ulcers d. Maintaining the patient's legs in a dependent position

a. Teaching the patient the correct use of compression stockings

A nurse is assessing a client's cardiovascular system. To palpate for unexpected pulsations in the pulmonic area, at which anatomical location should the nurse place her fingers? a. The left second intercostal space b. The right second intercostal space c. The left fifth intercostal space d. The left fifth intercostal space at the midclavicular line

a. The left second intercostal space a is also known as the pulmonic area b is the aortic area d is the mitral/bicuspid/apical/point of maximum impulse (PMI) area **in HF, ventricular enlargement makes the PMI heard in the SIXTH intercostal space on the left side instead

A male patient who has coronary artery disease (CAD) has serum lipid values of LDL cholesterol of 98 mg/dL and HDL cholesterol of 47 mg/dL. What should the nurse include in patient teaching? a. The lipid levels are normal b. Increase intake of olive oil c. Consume a diet low in fats d. Reduce total caloric intake

a. The lipid levels are normal LDL should be less than 100 HDL should be greater than 40

An older adult patient with chronic heart failure (HF) and atrial fibrillation asks the nurse why warfarin has been prescribed to continue at home. What is the BEST response by the nurse? a. The medication prevents blood clots from forming in your heart b. The medication increases your heart rate so that clots do not form in your heart c. The medication dissolves clots that develop in your coronary arteries d. The medication reduces clotting by decreasing serum potassium levels

a. The medication prevents blood clots from forming in your heart Chronic HF causes enlargement of chambers of the heart, allowing the blood to pool. It alters the electrical pathway in atria, causing a-fib and thrombus formation within the atria

When providing nutritional counseling for patients at risk for coronary artery disease, which foods would the nurse encourage patients to include in their diet? Select all that apply. a. Tuna fish b. Whole milk c. Orange juice d. Walnuts e. Tofu

a. Tuna fish d. Walnuts e. Tofu Tuna fish, tofu, and walnuts are all rich in omega-3 fatty acids, and have been shown to lower risk of CAD when consumed regularly

Which antilipemic medications should the nurse question for a patient with cirrhosis of the liver? Select all that apply. a. gemfibrozil (Lopid) b. ezetimibe (Zetia) c. Niacin d. Cholestyramine e. atorvastatin (Lipitor)

a. gemfibrozil (Lopid) b. ezetimibe (Zetia) e. atorvastatin (Lipitor) Zetia should not be used with liver impairment. Lipitor adverse effects include liver damage and myopathy.

Homocysteine

amino acid from protein breakdown (cardiovascular disease)

stroke volume

amount of blood ejected from the ventricle with each heartbeat **volume wrung out of the sponge needed to be optimal to fill the bucket**

Indications for drawing cardiac enzymes and lipid profile:

angina MI heart disease hyperlipidemia

premature atrial complexes (PACs)

atrial tissue fires an impulse before the next sinus impulse is due (AV node has not fully repolarized before next pump) food intake or stress can be causative factor treat: remove stressors/lifestyle changes, use beta blockers or calcium channel blockers

A nurse in the emergency department is caring for a client who took 3 nitroglycerin tablets sublingually for chest pain. The client reports relief from the chest pain but now he is experiencing a headache. Which of the following statements should the nurse make? a. "A headache is an indication of an allergy to the medication." b. "A headache is an expected adverse effect of the medication." c. "A headache indicates tolerance to the medication." d. "A headache is likely due to the anxiety about the chest pain."

b. "A headache is an expected adverse effect of the medication." a is incorrect because it is not an indication of an allergy. b is correct because the headache is occurring from vasodilation happening in the brain from taking nitro.

A nurse is caring for a client who is scheduled for an exercise stress test. Which of the following comments made by the client should indicate to the nurse that the client requires further teaching? a. "I will not smoke prior to my test." b. "I'll take my heart medications the morning of my test." c. "I'll get 8 hours of sleep the night before the test." d. "I'll skip my coffee the morning of the test."

b. "I'll take my heart medications the morning of my test." a is true, because smoking increases heart rate, potentially skewing the test results b is false and therefore the answer, because beta blockers and calcium channel blockers can alter the results from being accurate for an exercise stress test c is true, the client should be well rested before the test d is true, caffeine increases heart rate, and if they decided to do the medication form of a stress test, caffeine is the antidote to the medication, so the test wouldn't work

Which patient is at GREATEST risk for sudden cardiac death (SCD)? a. A 42 yo white woman with HTN and dyslipidemia b. A 52 yo African American man with left ventricular failure c. A 62 yo obese man with diabetes mellitus and high cholesterol d. A 72 yo Native American woman with a family history of heart disease

b. A 52 yo African American man with left ventricular failure Patients with left ventricular failure after MI are at greatest risk for SCD. Other risk factors for SCD: male gender, African American race, family history of premature atherosclerosis, tobacco use, diabetes mellitus, hypercholesterolemia, hypertension, and cardiomyopathy

A nurse has received change-of-shift report on a group of clients and is preparing her assignment. Which of the following clients should the nurse assess FIRST? a. A client who had a blood glucose reading at 0650 of 70 mg/dL after receiving 50% dextrose for a hypoglycemic episode b. A client who was admitted for chest pain and is reporting a new onset of indigestion c. A client who has pneumonia and was treated for a temperature of 102 degrees F at 0400 d. A client who has pulled out the peripheral IV catheter and is scheduled to receive a dose of famotidine at 0800

b. A client who was admitted for chest pain and is reporting a new onset of indigestion a is incorrect, 70 is okay b is correct, vitals need to be taken and their status could be getting worse c is incorrect, fever is expected with pneumonia d is incorrect, a new IV can be put in later on before the medication is given

The patient is being dismissed from the hospital after acute coronary syndrome and will be attending rehabilitation. What information would be taught in the early recovery phase of rehabilitation? a. Attention will focus on management of chest pain, anxiety, dysrhythmias, and other complications b. Activity level is gradually increased under cardiac rehabilitation team supervision and with EKG monitoring c. Physical activity is always started in the hospital and continued at home d. Therapeutic lifestyle changes should become lifelong habits

b. Activity level is gradually increased under cardiac rehabilitation team supervision and with EKG monitoring

For which problem is percutaneous coronary intervention (PCI) MOST clearly indicated? a. Coronary artery disease b. Acute myocardial infarction c. Left-sided heart failure d. Chronic stable angina

b. Acute myocardial infarction

A patient reports dizziness and SOB and is admitted with a dysrhythmia. Which medication, if ordered, requires the nurse to carefully monitor the patient for asystole? a. Metoprolol b. Adenosine c. Digoxin d. Atropine sulfate

b. Adenosine first drug of choice to convert SVT to NSR. given rapidly with rapid flush immediately after. A brief moment of asystole after administration is expected and common

A nurse is providing discharge teaching to a client who has peripheral arterial disease (PAD). Which of the following instructions should the nurse include in the teaching? a. Apply a heating pad on a low setting to help relieve leg pain b. Adjust the thermostat so that the environment is warm c. Wear antiembolic stockings during the day d. Rest with the legs above heart level

b. Adjust the thermostat so that the environment is warm a is incorrect because heat shouldn't be directly applied to the legs in arterial diseases d/t loss of sensation c is incorrect because the stockings would push fluid from the interstitial spaces into circulation and they're used for venous diseases d is incorrect because resting your legs above heart level in arterial diseases makes things worse

The nurse is reviewing the laboratory test results for a 68 yo patient whose warfarin (Coumadin) therapy was terminated during the preoperative period. On postoperative day 2, the INR result is 2.7. Which action by the nurse is MOST appropriate? a. Call the physician to request an increased dose of warfarin b. Administer the daily dose of warfarin c. Hold the daily dose of warfarin d. Teach the patient signs and symptoms of bleeding

b. Administer the daily dose of warfarin

A nurse is teaching a client who has a new prescription for transdermal nitroglycerin to treat angina pectoris. Which of the following instructions should the nurse include in the teaching? a. Apply a new transdermal patch once a week b. Apply the transdermal patch in the morning c. Apply the transdermal patch in the same location as the previous patch d. Apply a new transdermal patch when chest pain is experienced

b. Apply the transdermal patch in the morning a is incorrect because a new patch should be applied daily, not weekly - 12 hr on/12 hr off c is incorrect because you should alternate places the patch is placed d is incorrect because nitro should be used sublingually with a spray or tablet if chest pain is experienced for faster relief, not transdermally with a patch

The nurse is caring for a patient who is 24 hours post pacemaker insertion. Which nursing intervention is MOST appropriate at this time? a. Encouraging range-of-motion exercises of the involved arm b. Assessing the incision for any redness, swelling, or discharge c. Applying wet-to-dry dressings every 4 hours to the insertion site d. Reinforcing the pressure dressing as needed

b. Assessing the incision for any redness, swelling, or discharge Note for signs of infection

A patient who had bladder surgery 2 days ago develops acute decompensated heart failure (ADHF) with severe dyspnea. Which action by the nurse would be indicated FIRST? a. Perform a bladder scan to assess for urinary retention b. Assist the patient to a sitting position with arms on the overbed table c. Restrict the patient's oral fluid intake to 500 mL/day d. Instruct the patient to use pursed-lip breathing until the dyspnea subsides

b. Assist the patient to a sitting position with arms on the overbed table high-fowlers position with feet horizontal in the bed or dangling at the bedside helps decrease venous return because of the pooling of blood to the extremities and increases ventilation

A nurse in an urgent care center is assessing a client who reports a sudden onset of irregular palpitations, fatigue, and dizziness. The nurse finds a rapid and irregular heart rate with a significant pulse deficit. Which of the following dysrhythmias should the nurse expect to find on the EKG? a. First-degree AV block b. Atrial fibrillation c. Sinus bradycardia d. Sinus tachycardia

b. Atrial fibrillation a is incorrect, rhythm would not be irregular b is correct, pulse deficit is a key sign of a-fib c is incorrect, rhythm would not be rapid or irregular d is incorrect, rhythm would not be irregular

The nurse is preparing to administer a nitroglycerin patch to a patient. When providing instructions regarding the use of the patch, what should the nurse include in the teaching? a. Avoid nonsteroidal antiinflammatory drugs (NSAIDs) b. Avoid drugs that treat erectile dysfunction c. Avoid over the counter H2-receptor blockers d. Avoid high-potassium foods

b. Avoid drugs that treat erectile dysfunction Use of erectile drugs concurrent with nitrates creates a severe risk of hypotension and possibly death

The nurse is caring for a patient admitted with a history of hypertension. The patient's medication history includes hydrochlorothiazide daily for the past 10 years. Which parameter would indicate the optimal intended effect of this drug therapy? a. Output of 600 mL per 8 hours b. BP 128/86 mmHg c. Weight loss of 2 lb d. Absence of ankle edema

b. BP 128/86 mmHg in first few weeks of therapy, diuretic effect diminishes, but antihypertensive effect remains

The nurse is caring for a patient who has been receiving warfarin (Coumadin) and digoxin (Lanoxin) as treatment for atrial fibrillation. Because the warfarin has been discontinued before surgery, the nurse should diligently assess the patient for which complication early in the postoperative period until the medication is resumed? a. Decreased cardiac output b. Cerebral or pulmonary emboli c. Excessive bleeding from incision or IV sites d. Increased blood pressure

b. Cerebral or pulmonary emboli

A patient returns after cardiac catheterization. Which nursing care would the registered nurse delegate to the licensed practical nurse? a. Take vital signs and report abnormal values b. Check for bleeding at the catheter insertion site c. Prepare discharge teaching related to complications d. Monitor the electrocardiogram for dysrhythmias

b. Check for bleeding at the catheter insertion site If bleeding is identified, it can be reported to the RN from the LPN. VS should be delegated to UAP. Prep of discharge and monitoring rhythms is under RN's scope

A nurse is caring for four clients. After administering morning medications, she realizes that the nifedipine prescribed for one client was inadvertently administered to another client. Which of the following actions should the nurse take FIRST? a. Notify the client's provider b. Check the client's vital signs c. Fill out an occurrence form d. Administer the medication to the correct client

b. Check the client's vital signs nifedipine is a calcium channel blocker, so it decreases blood pressure and decreases heart rate

The nurse supervises an unlicensed assistant personnel (UAP) who is taking the blood pressure of a 58 yo obese female patient admitted with heart failure. Which action by the UAP will require the nurse to intervene? a. Taking the BP with the patient's arm at the level of the heart b. Deflating the blood pressure cuff at a rate of 8-10 mmHg per second c. Taking a forearm blood pressure because the largest cuff will not fit the patient's arm d. Waiting 2 minutes after position changes to take orthostatic pressures

b. Deflating the blood pressure cuff at a rate of 8-10 mmHg per second should be deflated at a rate of 2-3 mmHg per second

A patient is scheduled for a heart transplant. Beyond the first year after a heart transplant, the nurse knows that what is a major cause of death? a. Infection b. Acute rejection c. Immunosuppresion d. Cardiac vasculopathy

d. Cardiac vasculopathy accelerated coronary artery disease ^^ is a major cause of death post transplant.

A nurse is caring for a client who has pericarditis and reports feeling a new onset of palpitations and shortness of breath. Which of the following assessments should indicate to the nurse that the client may have developed atrial fibrillation? a. Different blood pressures in the upper limbs b. Different apical and radial pulses c. Differences between oral and axillary temperatures d. Differences in upper and lower lung sounds

b. Different apical and radial pulses different apical and radial pulses indicate a pulse deficit, which is a classic sign of A-fib

The nurse is caring for an older adult patient. What age-related cardiovascular changes should the nurse assess for when providing care for this patient? Select all that apply. a. Increased maximal heart rate b. Diminished pedal pulses c. Decreased maximal heart rate d. Systolic murmur e. Increased recovery time from activity

b. Diminished pedal pulses c. Decreased maximal heart rate d. Systolic murmur e. Increased recovery time from activity valvular rigidity leads to systolic murmur, arterial stiffening leads to diminished pedal pulses or possible increased BP, max heart rate tends to decrease, increased amt of time is necessary to recover from activity

A patient with a history of chronic hypertension is being evaluated in the emergency department for a blood pressure of 200/140 mmHg. Which patient assessment question is the PRIORITY? a. Does the patient need to urinate? b. Does the patient have a headache or confusion? c. Is the patient pregnant? d. Is the patient taking antiseizure medications as prescribed?

b. Does the patient have a headache or confusion? priority assessments should include neurologic deficits, retinal damage, heart failure, pulmonary edema, and renal failure

A nurse is caring for a client who has infective endocarditis. Which of the following manifestations is the priority for the nurse to monitor for? a. Anorexia b. Dyspnea c. Fever d. Malaise

b. Dyspnea b would be the priority and checked 1st c would be checked 2nd

A nurse is caring for a client who reports heart palpitations. An EKG confirms the client is experiencing ventricular tachycardia (VT). The nurse should anticipate the need for taking which of the following actions? a. Defibrillation b. Elective cardioversion c. CPR d. Radiofrequency catheter ablation

b. Elective cardioversion a is incorrect, patient is awake and reporting palpitations b is correct, cardioversion would shock heart and correct the rhythm c is incorrect, patient is awake and reporting palpitations d is incorrect, a catheter ablation is a therapeutic intervention, not acute

The nurse is caring for a patient with a recent history of deep vein thrombosis (DVT) who is scheduled for an emergency appendectomy. Vitamin K is ordered for immediate administration. The INR value is 1.0. Which nursing action is MOST appropriate? a. Administer the medication and seek an increased dose from the healthcare provider b. Hold the medication and record in the electronic medical record c. Hold the medication until the lab result is repeated to verify results d. Administer the medication as ordered

b. Hold the medication and record in the electronic medical record

A nurse is giving a presentation to a community group about preventing atherosclerosis. Which of the following should the nurse include as a modifiable risk factor for this disorder? (Select all that apply.) a. Genetic predisposition b. Hypercholesterolemia c. Hypertension d. Obesity e. Smoking

b. Hypercholesterolemia c. Hypertension d. Obesity e. Smoking a is a non-modifiable risk factor, because you can't change your genetic make-up. b, c, d, and e are all modifiable risk factors, because they can either be treated, quit, or improved upon.

Heart failure is mostly caused by: a. Pneumonia b. Hypertension c. Cancer d. Tuberculosis

b. Hypertension

A nurse is preparing to administer verapamil by IV bolus to a client who is having cardiac dysrhythmias. For which of the following adverse effects should the nurse monitor when giving this medication? a. Hyperthermia b. Hypotension c. Ototoxicity d. Muscle pain

b. Hypotension a main side effect of calcium channel blockers is decreased heart rate and blood pressure

After teaching a patient with chronic stable angina about nitroglycerin, the nurse recognizes the need for further teaching when the patient makes which statement? a. I will take the nitroglycerin 10 minutes before planned activity that usually causes chest pain b. I can take up to five tablets every 3 minutes for relief of my chest pain c. I will replace my nitroglycerin supply every 6 months d. I will take acetaminophen (Tylenol) to treat the headache caused by nitroglycerin

b. I can take up to five tablets every 3 minutes for relief of my chest pain Recommended dose of nitroglycerin is one tablet taken sublingually or one metered spray for symptoms of angina, repeated after 5 minutes if symptoms continue

The nurse instructs a 68 yo woman with hypercholesterolemia about natural lipid-lowering therapies. The nurse determines further teaching is necessary if the patient makes which statement? a. I should check with my physician before I start taking any herbal products b. I will take garlic instead of my prescription medication to reduce my cholesterol c. Herbal products do not go through as extensive testing as prescription drugs do d. Omega-3 fatty acids are helpful in reducing triglyceride levels

b. I will take garlic instead of my prescription medication to reduce my cholesterol

A patient with a history of myocardial infarction is scheduled for a transesophageal echocardiogram to visualize a suspected clot in the left atrium. What information should the nurse include when teaching the patient about this diagnostic study? a. Food and fluids are restricted for 2 hours before the procedure b. IV sedation may be administered to help the patient relax c. Ambulation is restricted for up to 6 hours before the procedure d. Contrast medium is injected into the esophagus to enhance images

b. IV sedation may be administered to help the patient relax Sedation eases the insertion of the tube into the esophagus. Food/fluids are restricted for at least 6 hours beforehand. Contrast medium is administered IV to evaluate the direction of blood flow if a septal defect is suspected.

The nurse assesses the right femoral artery puncture site as soon as the patient arrives after having a stent inserted into a coronary artery. The insertion site is not bleeding or discolored. What should the nurse do NEXT to ensure the femoral artery is in tact? a. Palpate the insertion site for induration b. Inspect the patient's right side and back c. Assess peripheral pulses in the right leg d. Compare the color of the left and right legs

b. Inspect the patient's right side and back best to log roll the patient to inspect the right side ang back for retroperitoneal bleeding since the artery could be leaking and blood is drawn into the tissues by gravity

A nurse is assessing a male client who has advanced peripheral artery disease (PAD). Which of the following findings should the nurse expect? a. Thin, pliable toe nails b. Leg pain at rest c. Hairy legs d. Flushed, warm legs

b. Leg pain at rest a is incorrect, toenails would be thick b is correct because arterial diseases can lead to pain at rest due to poor circulation c is incorrect, legs would be hairless d is incorrect, legs would be cool/pallor

A nurse is caring for a client who has hypertension and has a potassium level of 6.8 mEq/L. Which of the following actions should the nurse take? a. Suggest that the client use a salt substitute b. Obtain a 12-lead EKG c. Advise the client to add citrus juices and bananas to her diet d. Obtain a blood sample for a serum sodium level

b. Obtain a 12-lead EKG a is incorrect, salt substitutes can raise potassium levels b is correct because a nurse should monitor the PT waves and if the QRS is widened on an EKG c is incorrect, citrus juices and bananas raise potassium levels

While assessing the cardiovascular status of a patient, the nurse performs auscultation. Which intervention should the nurse implement in the assessment during auscultation? a. Use the bell of the stethoscope when auscultating S1 & S2 b Palpate the radial pulse while auscultating the apical pulse c. Position the patient supine d. Ask the patient to hold their breath

b. Palpate the radial pulse while auscultating the apical pulse Sitting or side-lying is most appropriate for auscultation, but in order to detect any pulse deficits, it's important to check pulses at the same time

A 67 yo man with peripheral artery disease is seen in the primary care clinic. Which symptom reported by the patient would indicate to the nurse that the patient is experiencing intermittent claudication? a. Patient states the feet become red if he puts them in a dependent position b. Patient says muscle leg pain occurs with continued exercise c. Patient complains of chest pain with strenuous activity d. Patient has numbness and tingling of all his toes and both feet

b. Patient says muscle leg pain occurs with continued exercise

A nurse is planning care for a client following a cardiac catheterization accessed through his femoral artery. Which of the following actions should the nurse plan to take? a. Instruct the client to perform range of motion exercises to his lower extremities b. Perform neurovascular checks with vital signs c. Ambulate the client 1 hr following the procedure d. Restrict the client's fluid intake

b. Perform neurovascular checks with vital signs a is incorrect, the client should keep lower extremities still after being accessed femorally c is incorrect, the client should remain resting flat on his back post procedure d is incorrect, their fluid intake should be increased to flush dye out of system and keep kidneys functioning

A nurse is providing teaching to a client who has a family history of hypertension. The nurse should inform the client that his blood pressure of 124/84 mmHG places him in which of the following categories? a. Within the expected reference range b. Prehypertension c. Stage 1 hypertension d. Stage 2 hypertension

b. Prehypertension Expected reference range of a blood pressure is <120/<80

The nurse is caring for a preoperative patient who has an order for vitamin K by subcutaneous injection. The nurse should verify that which laboratory study is abnormal before administering the dose? a. Hemoglobin (Hgb) b. Prothrombin time (PT) c. Hematocrit (Hct) d. Partial thromboplastin time (aPTT)

b. Prothrombin time (PT)

A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin? a. Hemoglobin (Hgb) b. Prothrombin time (PT) c. Bleeding time d. Activated partial thromboplastin time (aPTT)

b. Prothrombin time (PT) INR is also something you would check. aPPT is used to check for therapeutic levels of heparin. Antidote for warfarin: Vitamin K Antidote for heparin: Protamine sulfate

The nurse is caring for a patient with hypertension who is scheduled to receive a dose of metoprolol (Lopressor). The nurse should withhold the dose and consult the prescribing physician for which vital sign taken just before administration? a. BP 118/74 mmHg b. Pulse 48 bpm c. O2 saturation 93% d. RR 24

b. Pulse 48 bpm metoprolol is a b1-adrenergic blocking agent, so it can cause bradycardia and hypotension as adverse effects

A client has a new prescription for spironolactone (Aldactone). Which of the following laboratory values should the nurse recognize as a reason to hold the morning dose of this medication and notify the provider? a. Serum sodium 148 mEq/L b. Serum potassium 5.2 mEq/L c. Serum creatinine 1.2 mg/dL d. Serum chloride 106 mEq/L

b. Serum potassium 5.2 mEq/L The nurse should not administer spironolactone, a potassium-sparing diuretic, if the serum potassium is higher than 5.0. A serum sodium of 148 is elevated, but this would not be a contraindication to giving the medication. The serum creatinine and serum chloride levels are WNL ranges.

The nurse prepares to administer digoxin 0.125 mg to a patient admitted with influenza and a history of chronic heart failure. What should the nurse assess before giving the medication? a. Prothrombin time b. Serum potassium level c. Hemoglobin and hematocrit d. Urine specific gravity

b. Serum potassium level hypokalemia increases risk for dig toxicity

The home care nurse visits a patient with chronic heart failure. Which clinical manifestations, assessed by the nurse, would indicate acute decompensated heart failure? a. Respirations 26 breaths/min despire oxygen by nasal cannula b. Severe dyspnea and blood-streaked, frothy sputum c. Temperature is 100.4 and pulse is 102 bpm d. Fatigue, orthopnea, and dependent edema

b. Severe dyspnea and blood-streaked, frothy sputum manifestations of pulmonary edema include anxiety, pallor, cyanosis, clammy/cool skin, severe dyspnea, use of accessory muscles, RR >30, orhopnea, wheezing, coughing, frothy/blood tinged sputum, crackles, rhonchi

The patient with chronic heart failure is being discharged from the hospital. What information should the nurse emphasize in the patient's discharge teaching to prevent progression of the disease to acute decompensated heart failure (ADHF)? a. Encourage most activity in the morning when rested b. Take medications as prescribed c. Only ask the physician's office questions d. Use oxygen when feeling SOB

b. Take medications as prescribed goal is to avoid exasterbations and hospitalization.

A nurse is reviewing the health history for a client who has angina pectoris and a prescription for propranolol hydrochloride PO 40 mg twice daily. Which of the following findings in the history should the nurse report to the provider? a. The client has a history of hypothyroidism b. The client has a history of bronchial asthma c. The client has a history of hypertension d. The client has a history of migraine headaches

b. The client has a history of bronchial asthma propranolol is a noncardioselective beta blocker and can cause bronchoconstriction of the lungs

Which statement BEST describes the electrical activity of the heart represented by measuring the PR interval on the EKG? a. The length of time it takes for the atria to depolarize and repolarize b. The length of time for the electrical impulse to travel from the sinoatrial (SA) node to the Purkinje fibers c. The length of time it takes to depolarize the atrium d. The length of time it takes for the electrical impulse to travel from the sinoatrial (SA) node to the atrioventricular (AV) node

b. The length of time for the electrical impulse to travel from the SA node to the Purkinje fibers Electric impulse must pass from SA node, through AV node, to Purkinje fibers for synchronous atrial and ventricular contraction to occur. PR interval is from SA to Purkinje. P wave is from SA node through atrium. SA node to AV node is flat line between end of P wave and beginning of the Q wave that's usually not measured

The nurse is performing an assessment for a patient with fatigue and SOB. Auscultation of the heart reveals the presence of a murmur. What is this assessment finding indicative of? a. Friction between the heart and the myocardium b. Turbulent blood flow across a heart valve c. Increased viscosity of the patient's blood d. A deficit in heart conductivity that impairs normal contractility

b. Turbulent blood flow across a heart valve

Cardioversion is attempted for a patient with atrial flutter and rapid ventricular response. After the delivery of 50 joules by synchronized cardioversion, the patient develops ventricular fibrillation. Which action should the nurse take IMMEDIATELY? a. Administer 250 mL of 0.9% saline solution IV by rapid bolus b. Turn the synchronizer switch to "off" and recharge the device c. Assess the apical pulse, blood pressure, and bilateral neck vein distention d. Tell the patient to report any chest pain or discomfort and administer morphine sulfate

b. Turn the sychronizer switch to "off" and recharge the device V fib produces no effective cardiac contractions or output. Machine should shut off, recharge, and prepare for defibrillation

A nurse is providing discharge teaching for a client who has a new prescription of warfarin. Which of the following instructions should the nurse include in the teaching? a. Mild nosebleeds are common during initial treatment b. Use an electric razor while on this medication c. If a dose of the medication is missed, double the dose at the next scheduled time d. Increase fiber intake to reduce the adverse effect of constipation

b. Use an electric razor while on this medication a is incorrect because nose bleeds are not normal c is incorrect because the client should never double up on the medication d is incorrect because constipation is not an adverse effect of warfarin

A nurse is teaching a client who has a new diagnosis of venous insufficiency. Which of the following instructions should the nurse include? a. Apply ice packs to your legs b. Use elastic stockings c. Remain on bed rest d. Place your legs in a dependent position while in bed

b. Use elastic stockings a is incorrect, no ice should be used b is correct, you want the circulation and blood returning back up towards the heart and away from the lower extremities c is incorrect, you want the patient moving so more oxygen is needed to reach the tissues d is incorrect, the legs should be elevated

The nurse prepares to defibrillate a patient. For which dysrhythmia has the nurse observed in this patient? a. Uncontrolled atrial fibrillation b. Ventricular fibrillation c. Ventricular tachycardia with a pulse d. Third-degree AV block

b. Ventricular fibrillation Drug treatments are usually used for uncontrolled a-fib and v-tach with a pulse. Synchronized cardioversion as long as patient has a pulse. Pacemakers are used for AV blocks

The nurse is admitting a 68 yo preoperative patient with a suspected abdominal aortic aneurysm (AAA). The medication history reveals that the patient has been taking warfarin (Coumadin) on a daily basis. Based on this history and the patient's admission diagnosis, the nurse should prepare to administer which medication? a. Heparin sodium b. Vitamin K c. Protamine sulfate d. Cobalamin

b. Vitamin K

A patient is admitted with severe dyspnea, a history of heart failure, and chronic obstructive lung disease. Which diagnostic study would the nurse expect to be elevated if the cause of dyspnea was cardiac related? a. Serum homocysteine b. b-type natriuretic peptide (BNP) c. Serum potassium d. High-density lipoprotein (HDL)

b. b-type natriuretic peptide (BNP) elevation of BNP indicates the presence of heart failure. Elevations help to distinguish cardiac versus respiratory causes of dyspnea

metoprolol (Lopressor, Toprol-XL)

beta-adrenergic blocker

nebivolol (Bystolic)

beta-adrenergic blocker

propranolol (Inderal LA, InnoPran XL)

beta-adrenergic blocker

Drugs to prolong repolarization/disrupt arrhythmias

bretylium, AMIODARONE, ibutilide, sotalol

The nurse is preparing to administer digoxin (Lanoxin) 0.25mg IV push to a patient. Which is an expected patient outcome related to the administration of digoxin? a. Low serum potassium b. Reduction in urine output c. Increase in blood pressure d. Decrease in heart rate

d. Decrease in heart rate Digoxin has a negative chronotropic effect (decreased heart rate)

A nurse is providing discharge instructions for a client who has congestive heart failure. Which of the following client statements indicates to the nurse that the teaching was effective? a. "I will read food labels and limit my sodium to 4 grams per day." b. "I should use naproxen to manage discomfort." c. "I plan to slow down if I am tired the day after exercising." d. "I will take my diuretic before sleep and drink fluids during the day."

c. "I plan to slow down if I am tired the day after exercising." a is incorrect, sodium should be limited to 2 grams per day b is incorrect, NSAIDs like naproxen cause sodium retention, increasing blood pressure and fluid retention d is incorrect, diuretics should be taken in the morning, not before bed

A nurse is admitting a client who has acute heart failure following myocardial infarction (MI). The nurse recognizes that which of the following prescriptions by the provider requires clarification? a. Morphine sulfate 2 mg IV bolus every 2 hr PRN pain b. Laboratory testing of serum potassium upon admission c. 0.9% NS IV at 50 mL/hr continuous d. Bumetanide (Bumex) 1 mg IV bolus every 12 hr

c. 0.9% NS IV at 50 mL/hr continuous a, b, and d are all okay orders to give. Bumex is a potassium wasting diuretic, so it's important to check potassium. You should always question fluids for a patient with heart failure.

Which individuals would the nurse identify as having the HIGHEST risk for CAD? a. a 60 yo man with below normal homocysteine levels b. A 62 yo woman who has a sedentary lifestyle and BMI of 23 kg/m2 c. A 45 yo depressed man with a high-stress job d. A 54 yo woman vegetarian with elevated HDL levels

c. A 45 yo depressed man with a high-stress job Depression and stressful states can contribute to the development of CAD, elevated HDL and decreased homocysteine levels actually prevent CAD

Which person should the nurse identify as having the HIGHEST risk for abdominal aortic aneurysm? a. A 60 yo woman with renal insufficiency who is physically inactive b. A 40 yo woman with obesity and metabolic syndrome c. A 70 yo man with high cholesterol and hypertension d. A 65 yo woman with hyperhomocysteinemia and substance abuse

c. A 70 yo man with high cholesterol and hypertension

A nurse is preparing to administer medications to four clients. The nurse should administer medications to which of the following clients FIRST? a. A client who has pneumonia, a WBC count of 11,500/mm3, and is prescribed piperacillin b. A client who has anemia, hemoglobin of 11 g/dL, and is prescribed epoetin alfa c. A client who has renal failure, a serum potassium of 5.8/mEq/L, and is prescribed sodium polystyrene sulfonate d. A client who is post-coronary artery bypass graft (CABG), has a total cholesterol of 318 mg/dL, and is prescribed atorvastatin

c. A client who has renal failure, a serum potassium of 5.8/mEq/L, and is prescribed sodium polystyrene sulfonate a is incorrect, WBC count is high but not priority b is incorrect, hemoglobin is low but epoetin alfa will not work quickly c is correct, potassium level is high and needs to be taken care of d/t the renal failure d is incorrect, the cholesterol level is high, but atorvastatin does not work quickly

A 39 yo woman with a history of smoking and oral contraceptive use is admitted with a venous thromboembolism (VTE) and prescribed unfractionated heparin. What laboratory test should the nurse review to evaluate the expected effect of the heparin? a. International normalized ration (INR) b. Platelet count c. Activated partial thromboplastin time (aPTT) d. Activated clotting time (ACT)

c. Activated partial thromboplastin time (aPTT)

Despite a high dosage, a male patient who is taking nifedipine (Procardia XL) for antihypertensive therapy continues to have blood pressures over 140/90 mmHg. What should the nurse do NEXT? a. Ask him to make an exercise plan b. Request a prescription for a thiazide diuretic c. Assess his adherence to therapy d. Instruct him to use the DASH diet

c. Assess his adherence to therapy long-acting calcium channel blockers cause vascular smooth muscle relaxation, resulting in decreased systemic vascular resistance and arterial blood pressure and related side effects

In palpating the patient's pedal pulses, the nurse determines the pulses are absent. What factor could contribute to this result? a. Cardiac dysrhythmias b. Hyperthyroidism c. Atherosclerosis d. Arteriovenous fistula

c. Atherosclerosis Atherosclerosis can cause absent peripheral pulses. Feet would be cool/discolored.

Postoperative care of a patient undergoing coronary artery bypass graft (CABG) surgery includes monitoring for which common complication? a. Paralytic ileus b. Dehydration c. Atrial dysrhythmias d. Acute respiratory distress syndrome

c. Atrial dysrhythmias Postoperative dysrhythmias are common first 3 days after CABG

NCLEX QUESTION A patient is receiving a drug that decreases afterload. To evaluate the effect of the drug, the nurse monitors the patient's: a. Heart rate b. Lung sounds c. Blood pressure d. Jugular vein distention

c. Blood pressure

What is the PRIORITY assessment by the nurse caring for a patient receiving nesiritide to treat heart failure? a. Lung sounds b. Respiratory rate c. Blood pressure d. Urine output

c. Blood pressure All assessments are appropriate, but blood pressure is priority because you're monitoring for hypotension, the main adverse effect of nesiritide

An asymptomatic patient with acute decompensated heart failure (ADHF) suddenly becomes dyspneic. Before dangling the patient on the bedside, what should the nurse assess FIRST? a. Urine output b. Breath sounds c. Blood pressure d. Heart rhythm

c. Blood pressure Priority because blood pressure can decrease as blood pools in the periphery and preload decreases. If BP is low, place into semi-fowlers and use other measures to improve gas exchange

When evaluating a patient's knowledge regarding a low-sodium, low-fat cardiac diet, the nurse recognizes additional teaching is needed when the patient selects what food? a. Angel food cake b. Baked flounder c. Canned chicken noodle soup d. Baked potato with margarine

c. Canned chicken noodle soup canned soups are high in sodium content

A patient admitted to the emergency department 24 hours ago with complaints of chest pain was diagnosed with an ST-segment-elevation myocardial infarction (STEMI). What complication of myocardial infarction should the nurse anticipate? a. Unstable angina b. Sudden cardiac death c. Cardiac dysrhythmias d. Cardiac tamponade

c. Cardiac dysrhythmias present in 80-90% of patients after MI. Unstable angina is considered a precursor vs a complication. Tamponade is a rare event, and SCD would happen afterward

When looking at the EKG of the patient, the nurse knows that the QRS complex recorded on the EKG represents which part of the heart's beat? a. The length of time it takes for the impulse to travel from the atria to the ventricles b. Depolarization of the atria c. Depolarization from the atrioventricular (AV) node throughout the ventricles d. Repolarization of the ventricles

c. Depolarization from the atrioventricular (AV) node throughout the ventricles P wave represents depolarization of the atria QRS represents depolarization from the AV node throughout the ventricles T wave represents the repolarization of the ventricles

The nurse prepares a discharge teaching plan for a 44 yo male patient who has recently been diagnosed with coronary artery disease (CAD). Which risk factor should the nurse plan to focus on during the teaching session? a. Family cardiac history b. Hyperhomocysteinemia c. Elevated serum lipids d. Type A personality

c. Elevated serum lipids dislypidemia is one of the four major modifiable risk factors for CAD, including HTN, tobacco use, and physical inactivity

Which factor should be considered when caring for a women with suspected CAD? a. Women are more likely to develop collateral circulation b. Increased risk is present before menopause c. Fatigue may be the first symptom d. Classic signs and symptoms are expected

c. Fatigue may be the first symptom fatigue rather than pain or SOB, due to women not displaying normal signs of ischemia. Neck, throat, and back pain may be symptoms. Occurs more frequently after menopause. Men are more likely to develop collateral circulation

The patient has a potassium level of 2.9 mEq/L, and the nurse obtains the following measurements on the rhythm strip: HR 86 with a regular rhythm, the P wave is 0.06 sec and normal shape, the PR interval is 0.24 sec, and the QRS is 0.09 sec. How should the nurse document this rhythm? a. Second-degree AV block b. Premature ventricular contraction (PVC) c. First-degree AV block d. Premature atrial contraction (PAC)

c. First-degree AV block PR interval goes above 0.20 sec

A 73 yo man with dementia has a venous ulcer related to chronic venous insufficiency. The nurse should provide teaching on which type of diet for this patient and his caregiver? a. Low-fat diet b. Calorie-restricted diet c. High-protein diet d. High-carbohydrate diet

c. High-protein diet

The nurse performs discharge teaching for a patient with an implantable cardioverter-defibrillator (ICD). Which statement by the patient indicates to the nurse that further teaching is needed? a. The device may set off the metal detectors at the airport b. My family needs to keep up to date on how to perform CPR c. I can expect redness and swelling of the incision site for a few days d. I should not stand next to antitheft devices at the exit of stores

c. I can expect redness and swelling of the incision site for a few days Patient should be taught s/s of infection

The nurse is doing discharge teaching with the patient who received an implantable cardioverter-defibrillator (ICD) in the left side. Which statement by the patient indicates to the nurse that further teaching is required? a. I will call the cardiologist if my ICD fires b. I cannot drive until my cardiologist says it's ok c. I cannot fly because it will damage the ICD d. I cannot move my left arm until it is approved

c. I cannot fly because it will damage the ICD TSA needs to be informed because it can set off the metal detector and the screening wand should not be placed directly over the ICD

A 32 yo woman is prescribed diltiazen (Cardizem) for Raynaud's phenomenon. To evaluate the effectiveness of the medication, which assessment will the nurse perform? a. Improved skin turgor b. Decreased cardiac rate c. Improved finger perfusion d. Decreased mean arterial pressure

c. Improved finger perfusion

In caring for the patient with angina, the patient said, "While I was having a bowel movement, I started having the worst chest pain ever, like before I was admitted. I called for a nurse, then the pain went away." What further assessment data should the nurse obtain from the patient? a. What is your pain level on a scale of 0-10? b. What precipitated the pain? c. In what areas did you feel this pain? d. Has the pain changed this time?

c. In what areas did you feel this pain? Using PQRST, radiation of pain wasn't acknowledged

When teaching how lisinopril (Zestril) will help lower the patient's blood pressure, which mechanism of action should the nurse explain? a. Reduces sympathetic outflow from central nervous system b. Blocks b-adrenergic effects c. Inhibits conversion of angiotensin I to angiotensin II d. Relaxes arterial and venous smooth muscle

c. Inhibits conversion of angiotensin I to angiotensin II ACE inhibitors block this conversion, which reduces angiotensin II-mediated vasoconstriction and sodium and water retention

The nurse is admitting a patient who is scheduled to undergo a cardiac catheterization. What allergy information is MOST important for the nurse to assess and document before this procedure? a. Iron b. Penicillin c. Iodine d. Aspirin

c. Iodine Iodine-based contrast is usually used

The nurse is providing care for a patient who has decreased cardiac output related to heart failure. What should the nurse recognize about cardiac output? a. It is determined by measuring the electrical activity of the heart and the patient's heart rate b. It is the patient's average resting heart rate multiplied by the patient's mean arterial blood pressure c. It is calculated by multiplying the patient's stroke volume by the heart rate d. It is the average amount of blood ejected during one complete cardiac cycle

c. It is calculated by multiplying the patient's stroke volume by the heart rate

The nurse is caring for a newly admitted patient with vascular insufficiency. The patient has a new order for enoxaparin (Lovenox) 30 mg subcutaneously. What should the nurse do to correctly administer this medication? a. Sit the patient at a 30-degree angle before administration b. Use the back of the arm as the preferred site c. Leave the air bubble in the prefilled syringe d. Spread the skin before inserting the needle

c. Leave the air bubble in the prefilled syringe

The blood pressure of an older adult patient admitted with pneumonia is 160/70 mmHg. What is an age-related change that contributes to this finding? a. Increased parasympathetic activity b. Decreased adrenergic sensitivity c. Loss of elasticity in arterial vessels d. Stenosis of the heart valves

c. Loss of elasticity in arterial vessels Increasing resistance to flow, pressure is increased within the blood vessel, and hypertension results

A 74 yo man with a history of prostate cancer and hypertension is admitted to the emergency department with substernal chest pain. Which action will the nurse complete before administering sublingual nitroglycerin? a. Assess for CAD risk factors b. Administer morphine sulfate IV c. Obtain a 12-lead EKG d. Auscultate heart and lung soungs

c. Obtain a 12-lead EKG *If someone is experiencing chest pain:* 1. administer supplemental oxygen and position patient in upright position 2. assess vitals 3. obtain 12-lead 4. provide prompt pain relief first with nitrate followed by opioid analgesic if needed 5. auscultate heart sounds

The nurse is examining the EKG of a patient just admitted with a suspected MI. Which of the following EKG changes is MOST indicative of prolonged or complete coronary occlusion? a. Sinus tachycardia b. Prolonged PR interval c. Pathologic Q wave d. Fibrillarory P waves

c. Pathologic Q wave Presence of this often accompanies STEMI, indicative of complete coronary occlusion

A nurse is caring for a client who reports a new onset of severe chest pain. Which of the following actions should the nurse take to determine if the client is experiencing a myocardial infarction? a. Check the client's blood pressure b. Auscultate heart tones c. Perform a 12-lead EKG d. Determine if pain radiates to the left arm

c. Perform a 12-lead EKG a is incorrect because yes the nurse should get vitals, but it won't tell you it's an MI b is incorrect because listening to the client's heart won't tell you if they're having an MI d is incorrect because not every person experiencing an MI will have left arm pain

The nurse is preparing to administer a scheduled dose of enoxaparin (Lovenox) 30 mg subcutaneously. What should the nurse do to administer this medication correctly? a. Aspirate before injection to prevent IV administration b. Remove the air bubble in the prefilled syringe c. Pinch the skin between the thumb and forefinger before inserting the needle d. Rub the injection site after administration to enhance absorption

c. Pinch the skin between the thumb and forefinger before inserting the needle

A patient informs the nurse of experiencing syncope. Which nursing action should the nurse PRIORITIZE in the patient's subsequent diagnostic workup? a. Assessing the patient's knowledge of pacemakers b. Preparing an IV dose of a b-adrenergic blocker c. Preparing to assist with a head-up tilt-test d. Teaching the patient about the role of antiplatelet aggregators

c. Preparing to assist with a head-up tilt-test common component of diagnostic work up after patient feels syncope

A 52 yo male patient has received a bolus dose and an infusion of alteplase (Activase) for an ST-segment elevation myocardial infarction (STEMI). Which patient assessment would determine the effectiveness of the medication? a. Blood in the urine or stool b. Tachycardia with hypotension c. Presence of chest pain d. Decreased LOC

c. Presence of chest pain Alteplase is a fibrinolytic agent given to patients who had a STEMI. If effective, pain will resolve. Bleeding is common complication, resulting in decreased LOC, blood in urine/stool, increased HR, decreased BP

Assessment of a patient's peripheral IV site reveals that phlebitis has developed over the past several hours. Which intervention should the nurse implement FIRST? a. Administer prophylatic anticoagulants b. Apply an ice pack to the affected area c. Remove the patient's IV catheter d. Decrease the IV rate to 23-30 mL/hr

c. Remove the patient's IV catheter

When providing dietary instruction to a patient with hypertension, the nurse would advise the patient to restrict intake of which meat? a. Broiled fish b. Baked chicken breast c. Roasted duck d. Roasted turkey

c. Roasted duck Roasted duck is high in fat

The patient has atrial fibrillation with rapid ventricular response. What electrical treatment option does the nurse prepare the patient for? a. Defibrillation b. Automatic external defibrillator (AED) c. Synchronized cardioversion d. Implantable cardioverter-defibrillator (ICD)

c. Synchronized cardioversion

The patient informs the nurse that he does not understand how there can be a blockage in the left anterior descending artery (LAD), but there is damage to the right ventricle. What is the BEST response by the nurse? a. The one vessel curves around from the left side to the right ventricle b. The right ventricle is supplied during systole primarily by the right coronary artery c. The LAD supplies blood to the left side of the heart and part of the right ventricle d. It is actually on your right side of the heart, but we call it the left anterior descending vessel

c. The LAD supplies blood to the left side of the heart and part of the right ventricle the lower part of the right ventricle receives blood flow from the left anterior descending artery as well as the right coronary artery during diastole

A nurse is caring for a client who has atrial fibrillation and is receiving heparin. Which of the following findings is the nurse's priority? a. The client's EKG tracing shows irregular heart rate without P waves b. The client has an aPTT of 80 seconds c. The client experiences sudden weakness in one arm and leg d. The clients urine output is cloudy and odorless

c. The client experiences sudden weakness in one arm and leg a is incorrect, the EKG tracing isn't a priority b is incorrect, the aPTT shows potential of being an issue, but isn't yet c is correct, a stroke could be happening in the brain and it's an actual issue d is incorrect, irrelevant

A patient with long-standing history of heart failure recently qualified for hospice care. What measure should the nurse now PRIORITIZE when providing care for this patient? a. Pursue experimental therapies or surgical options b. Continue education for the patient and his family c. Taper the patient off his current medications d. Choose interventions to promote comfort and prevent suffering

d. Choose interventions to promote comfort and prevent suffering focus of hospice care ^^

The nurse informs the patient that she must wear intermittent sequential compression stockings after a surgical procedure. What is an appropriate rationale for nurse to give to a patient for the use of the device? a. The socks maintain the blood flow to the legs while the patient is on bed rest b. The socks keep the legs warm while the patient is not moving much c. The socks provide compression of the veins to keep the blood moving back to the heart d. The socks keep the blood pressure down while the patient is stressed after surgery

c. The socks provide compression of the veins to keep the blood moving back to the heart. SCD's prevent blood from pooling in the lower extremities that could cause deep vein thrombosis

Which instruction by the nurse is given to a patient who is about to undergo Holter monitoring is MOST appropriate? a. You should refrain from exercising while wearing this monitor b. You may remove the monitor only to shower or bathe c. You will need to keep a diary of all your activities and symptoms d. You should connect the monitor whenever you feel symptoms

c. You will need to keep a diary of all your activities and symptoms Holter monitor is worn for 24 continuous hours while patient participates in normal activities and keeps journal of activities and symptoms, but shouldn't bathe while wearing monitor

The nurse admits a 73 yo male patient with dementia for treatment of uncontrolled hypertension. The nurse will closely monitor for hypokalemia if the patient receives which medication? a. spironolactone (Aldactone) b. clonidine (Catapres) c. bumetanide (Bumex) d. amiloride (Midamor)

c. bumetanide (Bumex) Bumex is a loop diuretic, potassium wasting.

Which medication should the nurse question if prescribed together with ACE inhibitors? a. docusate sodium (Colace) b. furosemide (Lasix) c. potassium chloride (K-dur) d. morphine

c. potassium chloride (K-dur) ACE inhibitors block the conversion of angiotensin I to angiotensin II, thus also blocking the stimulus for aldosterone production. Aldosterone is responsible for potassium excretion; thus, a decrease in aldosterone production can result in an increase in serum potassium.

sinus arrhythmias

considered a normal rhythm and is associated with respirations quickening and slowing comes and goes irregularly = not indicative of an unhealthy heart

A nurse is caring for a client who has heart failure and a prescription for digoxin. Which of the following statements by the client indicates an adverse effect of the medication? a. "I can walk a mile a day." b. "I've had a backache for several days." c. "I am urinating more frequently." d. "I feel nauseated and have no appetite."

d. "I feel nauseated and have no appetite." Anorexia and N/V are the first adverse effects seen in those taking digoxin

A nurse is providing teaching to a client about interventions to reduce the risk of developing cardiovascular disease. Which of the following statements by the client should indicate to the nurse the need for further teaching? a. "A weight loss program can decrease my LDL cholesterol level." b. "Exercising regularly will increase HDL cholesterol levels." c. "Adding foods containing omega-3 fatty acids to my diet can lower my risk." d. "Increasing my intake of foods containing trans-fatty acids can lower my risk."

d. "Increasing my intake of foods containing trans-fatty acids can lower my risk." a is true b is true c is true d is false, indicating the client needs further teaching

When computing a heart rate from the EKG tracing, the nurse counts 15 of the small blocks between the R waves of a patient whose rhythm is regular. What does the nurse calculate the patient's heart rate to be? a. 60 bpm b. 75 bpm c. 150 bpm d. 100 bpm

d. 100 bpm Each small block on an EKG paper represents 0.04 sec, 1500 of these blocks represent 1 min. By dividing the number of small blocks (15) into 1500, the nurse can calculate the HR in a patient whose rhythm is regular (in this case, 100)

The nurse is monitoring the EKGs of several patients on a cardiac telemetry unit. The patients are directly visible to the nurse, and all of the patients are observed to be sitting up and talking with visitors. Which patient's rhythm would require the nurse to take immediate action? a. A 72 yo woman with atrial fibrillation with 60-80 QRS complexes per minute b. A 62 yo man with a fever and sinus tachycardia with a rate of 110 bpm c. A 42 yo woman with first-degree AV block and sinus bradycardia at a rate of 56 bpm d. A 52 yo man with premature ventricular contractions at a rate of 12 bpm

d. A 52 yo man with PVC at a rate of 12 bpm Frequent PVCs (more than 1 every 10 beats) may reduce cardiac output and precipitate angina and HF, depending on frequency

A nurse is caring for a patient with a diagnosis of deep venous thrombosis (DVT). The patient has an order to receive 30 mg enoxaparin (Lovenox). Which injection site should the nurse use to administer this medication safely? a. Back of the arm, 2 inches away from a mole b. Buttock, upper outer quadrant c. Anterolateral thigh, with no scar tissue nearby d. Abdomen, anterior-lateral aspect

d. Abdomen, anterior-lateral aspect

The nurse is reviewing the protocol for administration of IV adenosine (Adenocard). What is the MOST important nursing intervention to remember when giving this medication? a. Monitor the infusion site for hematoma b. Assess for burning sensation at the IV site c. Flush the IV catheter with normal saline d. Administer it as a fast IV push

d. Administer it as a fast IV push Adenosine must be given as rapidly as possible because it has an extremely short half-life of less than 10 seconds. For this reason, it is administered only IV and only as a fast IV push.

The nurse is administering a dose of digoxin to a patient with heart failure (HF). The nurse would become concerned with the possibility of digitalis toxicity if the patient reported what symptom? a. Muscle aches b. Constipation c. Pounding headache d. Anorexia/nausea

d. Anorexia/nausea anorexia, nausea, vomiting, blurred or yellow vision, and cardiac dysrhythmias are all signs of dig toxicity

The nurse observes no P waves on the patients monitor strip. There are fine, wavy lines between the QRS complexes. The QRS complexes measure 0.08 sec (narrow), but they occur irregularly with a rate of 120 bpm. What does the nurse determine the rhythm to be? a. Ventricular tachycardia b. Sinus tachycardia c. Ventricular fibrillation d. Atrial fibrillation

d. Atrial fibrillation A-fib is represented by irregular R-R intervals and small fibrillatory waves. No normal P waves because atria are not truly contracting, just fibrillating.

Calcium channel blockers

drugs that slow the movement of calcium into the cells of the heart and blood vessels. This in turn relaxes the blood vessels, increases the supply of oxygen-rich blood to the heart, and reduces the workload decrease in BP and HR

The nurse teaches a 28 yo man newly diagnosed with hypertension about lifestyle modifications to reduce his blood pressure. Which patient statement requires reinforcement of teaching? a. If i lose weight, I might not need to continue taking medications b. Diet changes can be as effective as taking blood pressure medications c. I will avoid adding salt to my food during or after cooking d. I can lower my blood pressure by switching to smokeless tobacco

d. I can lower my blood pressure by switching to smokeless tobacco Nicotine causes vasoconstriction and increases blood pressure

At a clinic visit, the nurse provides dietary teaching for a patient recently hospitalized with an exacerbation of chronic heart failure. The nurse determines that teaching is successful if the patient makes which statement? a. I can have unlimited amounts of foods labeled as reduced sodium b. I will take an extra diuretic pill when I eat a lot of salt c. I can add salt when cooking foods but not at the table d. I will limit the amount of milk and cheese in my diet

d. I will limit the amount of milk and cheese in my diet Salt shouldn't be added in prep or table. Diruetics should be taken as prescribed. Reduced sodium still has sodium

A 44 yo man is diagnosed with hypertension and receives a prescription for benazepril (Lotensin). After providing instruction, which statement by the patient indicates correct understanding? a. If I take this medication, I will not need to follow a special diet b. I will need to eat foods such as bananas and potatoes that are high in potassium c. It is normal to have some swelling in my face while taking this medication d. If I develop a dry cough while taking this medication, I should notify my doctor

d. If I develop a dry cough while taking this medication, I should notify my doctor common adverse effect of ACE inhibitors

A patient experienced sudden cardiac death (SCD) and survived. Which preventative treatment should the nurse expect to be implemented? a. Medications to prevent dysrhythmias b. An electrophysiologic study (EPS) c. External pacemaker d. Implantable cardioverter-defribrillator (ICD)

d. Implantable cardioverter-defibrillator (ICD) most common approach to preventing recurrence of SCD

A female patient who has type 1 diabetes mellitus has chronic stable angina that is controlled with rest. She states that over the past few months, she has required increasing amounts of insulin. What goal should the nurse use to plan care that should help prevent cardiovascular disease progression? a. Limit calories to daily limit b. Avoid saturated fat intake c. Exercise almost every day d. Keep Hgb A1C (A1C) less than 7%

d. Keep Hgb A1C (A1C) less than 7% If this is kept below 7%, the patient has kept good control over blood glucose over last 3 months

When teaching a patient about symptoms of hypokalemia, the nurse will instruct the patient to notify the health care provider if which symptom occurs? a. Diaphoresis b. Constipation c. Blurred vision d. Muscle weakness

d. Muscle weakness Muscle weakness is a common symptom of hypokalemia. The other answers are incorrect.

The patient is admitted with acute coronary syndrome (ACS). The EKG shows ST-segment depression and T-wave inversion. What should the nurse know that this indicates? a. A pacemaker is present b. Myocardia injury c. Myocardial infarction d. Myocardial ischemia

d. Myocardial ischemia ST depression and T wave inversion indicate myocardia ischemia from inadequate supply of blood and oxygen to the heart

When planning emergent care for a patient with a suspected myocardial infarction (MI), what should the nurse anticipate administrating? a. Oxygen, furosemide (Lasix), nitroglycerin, and meperidine b. Nitroglycerin, lorazepam (Ativan), oxygen, and warfarin (Coumadin) c. Aspirin, nitroprusside, dopamine, and oxygen d. Oxygen, nitroglycerin, aspirin, and morphine

d. Oxygen, nitroglycerin, aspirin, and morphine MONA for MI to improve oxygenation, relieve chest pain, decrease myocardial workload, and prevent further platelet aggregation

Which assessment finding would alert the nurse that a postoperative patient is not receiving the beneficial effects of enoxaparin (Lovenox)? a. Absence of arterial pulse in a lower extremity b. Crackles bilaterally in the lung bases c. Abdominal pain with decreased bowel sounds d. Pain and swelling in a lower extremity

d. Pain and swelling in a lower extremity

A patient with a recent diagnosis of heart failure has been prescribed furosemide. What outcome does the nurse anticipate will occur that demonstrates medication effectiveness? a. Promote vasodilation b. Increase in contractility c. Decrease in afterload d. Reduction of preload

d. Reduction of preload Diuretics such as furosemide are used in the treatment of heart failure to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do NOT influence afterload, contractility, or vessel tone.

After having a myocardial infarction (MI), the nurse notes the patient has jugular vein distention, gained weight, developed peripheral edema, and has a heart rate of 108 bpm. What should the nurse suspect is happening? a. Left-sided HF b. Chronic HF c. ADHF d. Right-sided HF

d. Right-sided HF MI is primary cause of HF. Jugular vein distention, weight gain, peripheral edema, and increased HR are manifestations of R-sided HF

In caring for a patient admitted with poorly controlled hypertension, which laboratory test result should the nurse understand as indicating the presence of target organ damage? a. Serum uric acid of 3.8 mg/dL b. Blood urea nitrogen of 15 mg/dL c. Serum potassium of 3.5 mEq/L d. Serum creatinine of 2.6 mg/dL

d. Serum creatinine of 2.6 mg/dL normal levels are 0.6-1.3, meaning the elevated level could indicate organ damage to kidneys

The UAP is taking orthostatic vital signs. In the supine postion, the BP is 130/80, and the HR is 80 bpm. In the sitting position, the BP is 140/80, and the HR is 90 bpm. Which action should the nurse instruct the UAP to take NEXT? a. Return the patient to supine position b. Record the BP and HR measurements c. Repeat the BP and HR in this position d. Take BP and HR with patient standing

d. Take BP and HR with patient standing orthostatic vital signs are taken first in supine position, then sitting, then standing, not repeated or delayed

orthopnea

dyspnea when lying flat -- leads toward CV cause

A postoperative patient asks the nurse why the physician ordered daily administration of enoxaparin (Lovenox). Which reply by the nurse is MOST appropriate? a. This medication is a narcotic pain medication that will help take away any muscle aches caused by positioning on the operating room table b. This medication will help lower you blood pressure to a safer level, which is very important after surgery c. This medication will help prevent breathing problems after surgery, such as pneumonia d. This medication will help prevent blood clots from forming in your legs until your level of activity, such as walking, returns to normal

d. This medication will help prevent blood clots from forming in your legs until your level of activity, such as walking, returns to normal

The nurse determines there is artifact on a patient's telemetry monitor. Which factor should the nurse assess for that could correct this issue? a. Electrodes in the wrong lead b. Disabled automaticity c. Stimulation of the vagus nerve fibers d. Too much hair under the electrodes

d. Too much hair under electrodes Artifact can be caused by muscle activity, electrical interference, insecure leads and electrodes

A patient presents to the emergency department with reports of chest pain for 3 hours. What component of his blood work is MOST clearly indicative of a myocardial infarction (MI)? a. Myoglobin b. C-reactive protein c. CK-MB d. Troponin

d. Troponin Troponin is the biomarker of choice in the diagnosis of MI, with sensitivity and specificity that exceed those of CK-MB and myoglobin. CRP levels are not used to diagnose acute MI

A patient with varicose veins has been prescribed compression stockings. Which nursing instruction would be MOST appropriate? a. Dangle your feet at your bedside for 5 minutes b. Try to keep your stockings on 24 hours a day, as much as possible c. Your stockings will be most effective if you can remove them for a few minutes several times a day d. While you're still lying in bed in the morning, put on your stockings

d. While you're still lying in bed in the morning, put on your stockings

The nurse is preparing to administer digoxin to a patient with heart failure. In preparation, laboratory results are reviewed with the following findings: sodium 139, potassium 5.6, chloride 103, flucose 106. What is the PRIORITY action by the nurse? a. Withhold the daily dose until the following day b. Give the digoxin with extra fluids to dilute the sodium level c. Give the digoxin with a salty snack, such as crackers d. Withhold the dose and report the potassium level

d. Withhold the dose and report the potassium level patient is hyperkalemic, making patient more prone to dig toxicity

A nurse is preparing to teach a group of women in a community volunteer group about heart disease. What should the nurse include in the teaching plan? a. Women experience more symptoms of heart disease at a younger age than men b. Women are often less ill when presenting for treatment of heart disease c. Women are less likely to delay seeking treatment than men d. Women are more likely to have noncardiac symptoms of heart disease

d. Women are more likely to have noncardiac symptoms of heart disease

A nurse is caring for a client who is prescribed isosorbide mononitrate (Imdur) for chronic stable angina and develops reflex tachycardia. Which of the following medications should the nurse expect to administer? a. furosemide (Lasix) b. captopril (Capoten) c. ranolazine (Ranexa) d. metoprolol (Lopressor)

d. metoprolol (Lopressor) Metoprolol is a beta-blocker that may be used to manage reflex tachycardia resulting from Imdur. Furosemide, captopril, and ranolazine are not used for this purpose.

preload

determines the amount of stretch placed on myocardial fibers. The volume of blood in the ventricles at the end of diastole, before the next contraction - degree of stretch **amount of fluid in the 1st bucket available for sponge to absorb**

Angiotensin II receptor antagonists "-sartan"

drugs that change the action of the renin-angiotensin-aldosterone system by blocking the effects of angiotensin II (vasoconstriction, water and sodium retention) by directly blocking the binding of angiotensin II to angiotensin II type 1 receptors opposite of fluid overload

Diuretics (loop and potassium-sparing)

drugs that control blood pressure by eliminating excess salt and water from body tissues and blood, reducing swelling. Some of these drugs relax arteries, which also lowers blood pressure

Beta blockers "-olol"

drugs that limit the activity of epinephrine (a hormone that increases BP). They reduce the heart rate and force of contraction, leading to decreased oxygen demand by the heart muscle

ACE inhibitors "-pril"

drugs that lower blood pressure by blocking the production of substances that constrict blood vessels they block an enzyme in the body that is necessary for production of angiotensin II, resulting in blood vessels relaxing and blood pressure is decreased lower BP

central-acting adrenergic agents

drugs that lower blood pressure by stimulating alpha-receptors in the brain, whcih wident peripheral arteries and ease blood flow

alpha blockers

drugs that oppose the excitatory effects norepinephrine released from sympathetic nerve endings at alpha receptors and cause blood vessel relaxation and vasodilation, leading to decrease in blood pressure

Assessment of precordium

inspection palpation percussion (sucks) AUSCULTATION for normal heart sounds, paradoxical splitting, gallops and murmurs, and pericardial friction rub

What can pain or discomfort in the chest result from?

ischemic heart disease pericarditis aoritc dissection pleurisy pulmonary embolus hiatal hernia anxiety

Brain Natriruetic Peptide (BNP)

left ventricle damage, HTN, HF get on admission and FOLLOW it

When patients are experiencing a dysrhythmia, assess:

look at patient ask how they're feeling check leads baseline vitals - usually lower O2 and increased temp LOC heart sounds for a full minute OLDCART

Normal and therapeutic range for INR

normal: 1 therapeutic: 2-3

Normal and therapeutic range for prothrombin time (PT)

normal: 11-16 therapeutic: 35-70 greater than/equal to 90: PROBLEM

heart rate

number of times the heart beats in one minute **running fast between the two buckets**

What is a lipid profile used for?

provides info regarding cholesterol levels and is used as an early indication of heart disease

Supraventricular tachycardia

rapid stimulation of atrial tissue at 100-280 bpm can have palpitations or no symptoms p&t waves merge, qrs normal - difficult to measure can be due to pain/anxiety/dehydration treatment: cardizem, adenosine, cardioversion, or cardioablation

Venous disease symptoms __ __ V <--- those are legs with the feet up btw

symptoms display "drowning" **veins carry unoxygenated blood TO the heart** edema "ruddy"/brownish color in legs (RBC's stay in lower extremities and die because fluid is trapped and blood isn't circulating back up toward the heart) pulses intact itchy, weeping, wet ulcers with abnormal shape antiembolic stocking (TEDS) use -- want to elevate feet! DVT

Arterial disease symptoms __A__ <---- those are legs with the feet down on the ground btw

symptoms display "starving" **arteries carry oxygenated blood away from the heart to the rest of the body** intermittent claudication cool extremeties decreased/loss of sensation in legs -- feet should stay DOWN to allow blood circulation to lower extremeties pallor loss of hair shiny skin weak/diminished pulses or pulseless dry, perfectly rounded ulcers necrotic toes/thick toenails chronic pain with exercise can develop into leg pain at rest.... stable angina

contractility

tension developed and strength of fibers during the preload and afterload **the force used to wring out the sponge**

Identifying details of Sinus Bradycardia

when the rate of sinus node discharge is less than 60 bpm

Identifying details of Sinus Tachycardia

when the rate of the SA node discharge exceeds 100 bpm