lww cardio
The nurse is assessing a patient who complains of feeling "light-headed." When obtaining orthostatic vital signs, what does the nurse determine is a significant finding? a) An increase of 5 mm Hg in diastolic pressure b) An increase of 10 mm Hg blood pressure reading c) A heart rate of more than 20 bpm above the resting rate d) An unchanged systolic pressure
A heart rate of more than 20 bpm above the resting rate Explanation: Normal postural responses that occur when a person moves from a lying to a standing position include (1) a heart rate increase of 5 to 20 bpm above the resting rate; (2) an unchanged systolic pressure, or a slight decrease of up to 10 mm Hg; and (3) a slight increase of 5 mm Hg in diastolic pressure. Postural (orthostatic) hypotension is a sustained decrease of at least 20 mm Hg in systolic BP or 10 mm Hg in diastolic BP within 3 minutes of moving from a lying or sitting to a standing position (Freeman et al., 2011). It is usually accompanied by dizziness, lightheadedness, or syncope
A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which of the following patient findings requires immediate intervention by the nurse? a) Altered level of consciousness b) Chest pain: 2 of 10 (1-to-10 pain scale) c) Minimal oozing of blood from the IV site d) Presence of reperfusion dysrhythmias
Altered level of consciousness Explanation: A patient receiving fibrinolytic therapy is at risk for complications associated with bleeding. Altered level of consciousness may indicate hypoxia and intracranial bleeding and the infusion should be discontinued immediately. Minimal bleeding requires manual pressure. Reperfusion dysrhythmias are an expected finding. A chest pain score of 2 is low, and indicates the patient's chest pain is subsiding, an expected outcome of this therapy.
After percutaneous transluminal coronary angioplasty (PTCA), the nurse suspects that a patient, who is on bed rest, may be experiencing the complication of bleeding. The nurse's initial action should be to do which of the following? a) Decrease anticoagulant or antiplatelet therapy. b) Review the results of the latest blood cell count, especially the hemoglobin and hematocrit. c) Notify the health care provider. d) Apply manual pressure at the site of the insertion of the sheath.
Apply manual pressure at the site of the insertion of the sheath. Explanation: The immediate nursing action would be to apply pressure, which may stop the bleeding. If the bleeding does not stop, the health care provider needs to be notified.
The nurse understands that a patient with which cardiac arrhythmia is most at risk for developing heart failure? a) Supraventricular tachycardia b) Atrial fibrillation c) Sinus tachycardia d) First-degree heart block
Atrial fibrillation Explanation: Cardiac dysrhythmias such as atrial fibrillation may either cause or result from HF; in both instances, the altered electrical stimulation impairs myocardial contraction and decreases the overall efficiency of myocardial function.
A patient tells the nurse "my heart is skipping beats again; I'm having palpitations." After completing a physical assessment, the nurse concludes the patient is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the patient to complete which of the following? a) Request sublingual nitroglycerin. b) Apply supplemental oxygen. c) Avoid caffeinated beverages. d) Lie down and elevate the feet.
Avoid caffeinated beverages. Explanation: If PACs are infrequent, no medical interventions are necessary. Causes of PACs include caffeine, alcohol, nicotine, stretched atrial myocardium (e.g., as in hypervolemia), anxiety, hypokalemia (low potassium level), hypermetabolic states (e.g., with pregnancy), or atrial ischemia, injury, or infarction. The nurse should instruct the patient to avoid caffeinated beverages.
A patient has undergone a cardiac catheterization. He is to be discharged today. What information should the nurse emphasize during discharge teaching? a) Avoid heavy lifting for the next 24 hours. b) New bruising at the puncture site is normal. c) Take a tub bath, rather than a shower. d) Bend only at the waist.
Avoid heavy lifting for the next 24 hours. Explanation: For the next 24 hours, the patient should not bend at the waist, strain, or life heavy objects. The patient should avoid tub baths, but shower as desired. The patient should call her the health care provider if she has any bleeding, swelling, new bruising, or pain from her procedure puncture site, or a temperature of 101.5 degrees Fahrenheit or more.
The nurse is caring for a client with Raynaud's disease. What is an important instruction for a client who is diagnosed with this disease to prevent an attack? a) Avoid fatty foods and exercise. b) Avoid situations that contribute to ischemic episodes. c) Report changes in the usual pattern of chest pain. d) Take over-the-counter decongestants.
Avoid situations that contribute to ischemic episodes. Explanation: Teaching for clients with Raynaud's disease and their family members is important. They need to understand what contributes to an attack. The nurse should instruct the clients to avoid situations that contribute to ischemic episodes. Reporting changes in the usual pattern of chest pain or avoiding fatty foods and exercise does not help the client to avoid an attack; it is more contributory for clients with CAD. In addition, the nurse advises clients to avoid over-the-counter decongestants.
A client is receiving nitroglycerin ointment (Nitro-Dur) to treat angina pectoris. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's response and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin? a) Temperature of 100.2° F (37.9° C) b) Pulse rate of 84 beats/minute c) Blood pressure 84/52 mm Hg d) Respiration 26 breaths/minute
Blood pressure 84/52 mm Hg Explanation: Hypotension and headache are the most common adverse effects of nitroglycerin. Therefore, blood pressure is the vital sign most likely to reflect an adverse effect of this drug. The nurse should check the client's blood pressure 1 hour after administering nitroglycerin ointment. A blood pressure decrease of 10 mm Hg is within the therapeutic range. If blood pressure falls more than 20 mm Hg below baseline, the nurse should remove the ointment and report the finding to the physician immediately. An above-normal heart rate (tachycardia) is a less common adverse effect of nitroglycerin. Respiratory rate and temperature don't change significantly after nitroglycerin administration.
The nursing instructor is teaching their clinical group how to assess a client for congestive heart failure. How would the instructor teach the students to assess a client with congestive heart failure for nocturnal dyspnea? a) By questioning how many pillows the client normally uses for sleep b) By collecting the client's urine output c) By observing the client's diet during the day d) By measuring the client's abdominal girth
By questioning how many pillows the client normally uses for sleep Explanation: The nurse should ask the client about nocturnal dyspnea by questioning how many pillows the client normally uses for sleep. This is because being awakened by breathlessness may prompt the client to use several pillows in bed. Collecting the client's urine output, observing the client's diet, or measuring the client's abdominal girth does not help assess for nocturnal dyspnea.
A client has been prescribed furosemide (Lasix) 80 mg twice daily. The cardiac monitor technician informs the nurse that the client has started having rare premature ventricular contractions followed by runs of bigeminy lasting 2 minutes. During the assessment, the nurse determines that the client is asymptomatic and has stable vital signs. Which of the following actions should the nurse perform next? a) Summon the nurse-manager. b) Call the physician. c) Check the client's potassium level. d) Administer potassium.
Check the client's potassium level. Explanation: The client is asymptomatic but has had a change in heart rhythm. More information is needed before calling the physician. Because the client is taking furosemide (Lasix), a potassium-wasting diuretic, the next action would be to check the client's potassium level. The nurse would then call the physician with a more complete database. The physician will need to be notified after the nurse checks the latest potassium level. Calling the nurse-manager is not indicated at this time. Administering potassium requires a physician's order.
A middle-aged male presents to the ED complaining of severe chest discomfort. Which of the following patient findings is most indicative of a possible MI? a) Intermittent nausea and emesis for 3 days b) Anxiousness, restlessness, and lightheadedness c) Cool, clammy, diaphoretic, and pale appearance d) Chest discomfort not relieved by rest or nitroglycerin
Chest discomfort not relieved by rest or nitroglycerin Explanation: Chest pain or discomfort not relieved by rest or nitroglycerin is associated with an acute MI. The other findings, although associated with ACS (acute coronary syndrome) or MI, may also occur with angina and, alone, are not indicative of an MI.
The nurse is taking a health history from a client admitted with the medical diagnosis of cardiovascular disease (CVD). Identify which of the following symptoms indicate CVD. a) Dizziness, rash, extra-ocular eye movements b) Chest pain, weight gain, fatigue c) Fatigue, ecchymosis, confusion d) Petechiae, ascites, constipation
Chest pain, weight gain, fatigue Explanation: Chest pain, weight gain, fatigue, dizziness, ascites, and confusion are all symptoms of CVD. Rash, extra-ocular eye movements, ecchymosis, and petechiae are not usually indicative of CVD.
Which of the following medications is given to patients diagnosed with angina and is allergic to aspirin? a) Amlodipine (Norvasc) b) Clopidogrel (Plavix) c) Diltiazem (Cardizem) d) Felodipine (Plendil)
Clopidogrel (Plavix) Explanation: Plavix or Ticlid is given to patients who are allergic to aspirin or given in addition to aspirin to patients at high risk for MI. Norvasc, Cardizem, and Plendil are calcium channel blockers.
The nurse determines that a patient has a characteristic symptom of pericarditis. What symptom does the nurse recognize as significant for this diagnosis? a) Fatigue lasting more than 1 month b) Uncontrolled restlessness c) Constant chest pain d) Dyspnea
Constant chest pain Explanation: The most characteristic symptom of pericarditis is chest pain, although pain also may be located beneath the clavicle, in the neck, or in the left trapezius (scapula) region. Pain or discomfort usually remains fairly constant, but it may worsen with deep inspiration and when lying down or turning.
A client is hospitalized for repair of an abdominal aortic aneurysm. The nurse must be alert for signs and symptoms of aneurysm rupture and thus looks for which of the following? a) Slow heart rate and high blood pressure b) Higher than normal blood pressure and falling hematocrit c) Constant, intense back pain and falling blood pressure d) Constant, intense headache and falling blood pressure
Constant, intense back pain and falling blood pressure Explanation: Indications of a rupturing abdominal aortic aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit.
A nurse taking care of a patient recently admitted to the ICU observes the patient coughing up large amounts of pink, frothy sputum. Auscultation of the lungs reveals course crackles to lower lobes bilaterally. Based on this assessment, the nurse recognizes this patient is developing which of the following problems? a) Bilateral pneumonia b) Acute exacerbation of chronic obstructive pulmonary disease c) Tuberculosis d) Decompensated heart failure with pulmonary edema
Decompensated heart failure with pulmonary edema Explanation: Large quantities of frothy sputum, which is sometimes pink or tan (blood tinged), may be produced, indicating acute decompensated HF with pulmonary edema.
A client is recovering from coronary artery bypass graft (CABG) surgery. Which nursing diagnosis takes highest priority at this time? a) Disabled family coping related to knowledge deficit and a temporary change in family dynamics b) Hypothermia related to exposure to cold temperatures and a long cardiopulmonary bypass time c) Anxiety related to an actual threat to health status, invasive procedures, and pain d) Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or impaired electrical conduction
Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or impaired electrical conduction Explanation: For a client recovering from CABG surgery, Decreased cardiac output is the most important nursing diagnosis; anesthetics or a long cardiopulmonary bypass time may depress myocardial function, leading to decreased cardiac output. Other possible causes of decreased cardiac output in this client include fluid volume deficit and impaired electrical conduction. Anxiety, Disabled family coping, and Hypothermia may be relevant but take lower priority at this time; maintaining cardiac output is essential to sustaining the client's life.
Which of the following are characteristics of arterial insufficiency? a) Aching, cramping pain b) Pulses are present, may be difficult to palpate c) Diminished or absent pulses d) Superficial ulcer
Diminished or absent pulses Explanation: A diminished or absent pulse is a characteristic of arterial insufficiency. Venous characteristics include superficial ulcer formation, an aching and cramping pain, and presence of pulses.
Frequently, what is the earliest symptom of left-sided heart failure? a) Chest pain b) Confusion c) Dyspnea on exertion d) Anxiety
Dyspnea on exertion Explanation: Dyspnea on exertion is often the earliest symptom of left-sided heart failure.
A client is admitted to the hospital with aortic stenosis. Which of the following assessment findings would indicate the development of left ventricular failure? a) Dyspnea, distended jugular veins, orthopnea b) Distended jugular veins, pedal edema, nausea c) Dyspnea, orthopnea, pulmonary edema d) Orthopnea, nausea, pedal edema
Dyspnea, orthopnea, pulmonary edema Explanation: Signs and symptoms of progressive left ventricular failure include breathing difficulties, such as orthopnea, PND, and pulmonary edema. Distended jugular veins, pedal edema, and nausea are signs and symptoms of right sided heart failure.
Which of the following diagnostic tests may reveal an enlarged left ventricle? a) Fluorescein angiography b) Positron emission tomography (PET) scan c) Computed tomographic scan d) Echocardiography
Echocardiography Explanation: Echocardiography reveals an enlarged left ventricle. Fluorescein angiography reveals leaking retinal blood vessels, and a PET scan is used to reveal abnormalities in blood pressure. A CT scan reveals structural abnormalities.
A patient is having an angiography to detect the presence of an aneurysm. After the contrast is administered by the interventionist, the patient begins to complain of nausea and difficulty breathing. What medication is a priority to administer at this time? a) Epinephrine b) Cimetidine (Tagamet) c) Hydrocortisone (Solu-Cortef) d) Metoprolol (Lopressor)
Epinephrine Explanation: Infrequently, a patient may have an immediate or delayed allergic reaction to the iodine contained in the contrast agent used in angiography. Manifestations include dyspnea, nausea and vomiting, sweating, tachycardia, and numbness of the extremities. Any such reaction must be reported to the interventionalist at once; treatment may include the administration of epinephrine, antihistamines, or corticosteroids.
You are caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client? a) Hypotension b) Fever c) Fluttering d) Nausea
Fluttering Explanation: Premature ventricular contractions usually cause a flip-flop sensation in the chest, sometimes described as "fluttering." Associated signs and symptoms include pallor, nervousness, sweating, and faintness. Symptoms of premature ventricular contractions are not nausea, hypotension, and fever.
Which of the following describes a situation in which the blood pressure is severely elevated and there is evidence of actual or probable target organ damage? a) Secondary hypertension b) Hypertensive emergency c) Hypertensive urgency d) Primary hypertension
Hypertensive emergency Explanation: A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage. Hypertensive urgency is a situation in which blood pressure is severely elevated but there is no evidence of actual or probable target organ damage. Secondary hypertension is high blood pressure from an identified cause, such as renal disease. Primary hypertension denotes high blood pressure from an unidentified source.
Which of the following is a potential cause of premature ventricular complexes (PVCs)? a) Hypovolemia b) Alkalosis c) Hypokalemia d) Bradycardia
Hypokalemia Explanation: PVCs can be caused by cardiac ischemia or infarction, increased workload on the heart (eg, exercise, fever, hypervolemia, heart failure, tachycardia), digitalis toxicity, acidosis, or electrolyte imbalances, especially hypokalemia.
A patient with endocarditis is being discharged home. In evaluating the effectiveness of patient teaching about how to prevent recurrence of the infection, the student nurse would expect the patient to state: a) I will ask for antibiotics whenever I have dental work done." b) "I am going to take an aspirin a day to prevent lesions around my valve." c) "I will always be on antibiotic therapy." d) "I will start an antibiotic when I am exposed to anyone with infections."
I will ask for antibiotics whenever I have dental work done." Explanation: The patient should take antibiotics for dental procedures that involve manipulation of gingival tissue or the periapical area of the teeth or perforation of the oral mucosa. Exceptions include routine anesthetic injections through noninfected tissue, placement of orthodontic brackets, loss of deciduous teeth, bleeding from trauma to the lips or oral mucosa, dental x-rays, adjustment of orthodontic appliances, and placement of removable prosthodontic or orthodontic appliances.
The nurse reviews a patient's lab results and notes a serum calcium level of 7.9 mg/dL. The nurse knows that this reading can also be associated with which of the following? a) Enhanced sensitivity to digitalis b) Inclination to ventricular fibrillation c) Impaired myocardial contractility d) Increased risk of heart block
Impaired myocardial contractility Explanation: Normal serum calcium is 8.9 to 10.3 mg/dL. A reading of 7.9 is below normal. Hypocalcemia is associated with slow nodal functioning and impaired myocardial contractility, which can increase the risk of heart failure.
A client with venous insufficiency is instructed to exercise, apply elastic stockings, and elevate the extremities. Which is the primary benefit for this nursing management regime? a) Increase venous congestion b) Improve venous return c) Strengthen venous valves d) Improve arterial flow
Improve venous return Explanation: The major goal in management of venous insufficiency is to promote venous circulation. Arterial flow improvement is not the goal of treatment for this disorder. Venous valves that are incompetent cannot be strengthened. Venous congestion is a complication of venous insufficiency.
A nursing student is giving to a client with heart failure a medication with a positive inotropic effect on the heart. The student asks what a "positive inotropic" effect is. The correct response would be which of the following? a) It causes the kidneys to retain fluid and increase intravascular volume. b) It increases the respiratory rate. c) It increases the heart rate. d) It increases the force of the myocardial contraction.
It increases the force of the myocardial contraction. Explanation: A positive inotropic effect increases the force of myocardial contraction. A positive chronotropic effect increases the heart rate. A positive inotropic effect will usually help slow respiratory rate and will increase blood flow through the kidneys, so fluid output will increase
A nurse is educating about lifestyle modifications for a group of clients with newly diagnosed hypertension. While discussing dietary changes, which of the following points would the nurse emphasize? a) The taste buds never adapt to decreased salt intake. b) It takes 2 to 3 months for the taste buds to adapt to decreased salt intake. c) There is usually no need to change alcohol consumption for clients with hypertension. d) A person with hypertension should never consume alcohol.
It takes 2 to 3 months for the taste buds to adapt to decreased salt intake. Explanation: It takes 2 to 3 months for the taste buds to adapt to changes in salt intake. Knowing this may help the client adjust to reduced salt intake. The client should be advised to limit alcohol intake.
When preparing a patient for a cardiac catheterization, the patient states that she has allergies to seafood. Which of the following medications may give to her prior to the procedure? a) Phenytoin (Dilantin) b) Methylprednisolone (Solu-Medrol) c) Lorazepam (Ativan) d) Furosemide (Lasix)
Methylprednisolone (Solu-Medrol) Explanation: Prior to cardiac catheterization, the patient is assessed for previous reactions to contrast agents or allergies to iodine-containing substances, as some contrast agents contain iodine. If allergic reactions are of concern, antihistamines or methylprednisolone (Solu-Medrol) may be administered to the patient before angiography is performed. Lasix, Ativan, and Dilantin do not counteract allergic reactions.
You are caring for a client with hypertension who is experiencing complications. What diagnostic test evaluates the efficiency or inefficiency of the heart to pump blood? a) Multiple gated acquisition (MUGA) scan b) Chest radiography c) Computed tomography scan d) Echocardiography
Multiple gated acquisition (MUGA) scan Explanation: The MUGA is a test that detects how efficiently or inefficiently the heart pumps blood. Echocardiography and chest radiography are used to reveal an enlarged left ventricle. The computed tomography scan is used to reveal abnormalities in blood pressure.
The physician is ordering a test for the hypertensive client that will be able to evaluate whether the client has experienced heart damage. Which diagnostic test would the nurse anticipate to determine heart damage? a) Multiple gated acquisition scan (MUGA) b) Fluorescein angiography c) Blood chemistry d) Chest radiograph
Multiple gated acquisition scan (MUGA) Explanation: The nurse realizes that undiagnosed (untreated), long-standing hypertension can cause heart damage. The diagnostic test that best determines heart damage is the multiple gate acquisition scan (MUGA). This test is used to detect how efficiently the heart pumps. A blood chemistry determines electrolyte balance. A chest radiograph (chest x-ray) can provide details of the heart size through shading on the scan. Fluorescein angiography is an ophthalmologic test revealing leaking retinal blood vessels.
Aortic dissection may be mistaken for which of the following disease processes? a) Angina b) Stroke c) Myocardial infarction (MI) d) Pneumothorax
Myocardial infarction (MI) Explanation: Aortic dissection may be mistaken for an acute MI, which could confuse the clinical picture and initial treatment. Aortic dissection is not mistaken for stroke, pneumothorax, or angina.
A patient with impaired renal function is scheduled for a multidetector computer tomography (MDCT) scan. What preprocedure medication may the nurse administer to this patient? a) Epinephrine b) Dipyridamole (Persantine) c) Oral N-acetylcysteine d) Oral iodine
Oral N-acetylcysteine Explanation: Patients with impaired renal function scheduled for MDCT may require preprocedural treatment to prevent contrastinduced nephropathy. This may include oral or IV hydration 12 hours preprocedure; administration of oral N-acetylcysteine, which acts as an antioxidant; and/or administration of sodium bicarbonate, which alkalinizes urine and protects against free radical damage (Rundback, Nahl, & Yoo, 2011).
The nurse is caring for a client with aortic regurgitation. The nurse knows to expect which of the following symptoms on physical examination? a) Increased urine output b) Headache and vomiting c) Nausea and low urine output d) Orthopnea and dyspnea
Orthopnea and dyspnea Explanation: Aortic regurgitation usually manifests as progressive left ventricular failure, resulting from blood flowing backward from the aorta to the left ventricle, and eventually into the lungs. Urine output would be decreased from lower cardiac output. Nausea and vomiting are symptoms of increased gastrointestinal pressure, which would result from right heart failure. Kidney failure could become a problem later if cardiac output became too low, but not initially. CVA and an infarcted bowel would not be caused by mitral regurgitation.
A physician admits a client with a history of I.V. drug abuse to the medical-surgical unit for evaluation for infective endocarditis. Nursing assessment is most likely to reveal that this client has: a) pulsus paradoxus. b) a scratchy pericardial friction rub. c) Osler's nodes and splinter hemorrhages. d) retrosternal pain that worsens during supine positioning.
Osler's nodes and splinter hemorrhages. Explanation: Infective endocarditis occurs when an infectious agent enters the bloodstream, such as from I.V. drug abuse or during an invasive procedure or dental work. Typical assessment findings in clients with this disease include Osler's nodes (red, painful nodules on the fingers and toes), splinter hemorrhages, fever, diaphoresis, joint pain, weakness, abdominal pain, a new or altered heart murmur, and Janeway's lesions (small, hemorrhagic areas on the fingers, toes, ears, and nose). Retrosternal pain that worsens when the client is supine, pulsus paradoxus, and pericardial friction rub are common findings in clients with pericarditis, not infective endocarditis.
The patient with cardiac failure is taught to report which of the following symptoms to the physician or clinic immediately? a) Persistent cough b) Increased appetite c) Weight loss d) Ability to sleep through the night
Persistent cough Explanation: Persistent cough may indicate an onset of left-sided heart failure. Loss of appetite should be reported immediately. Weight gain should be reported immediately. Frequent urination, causing interruption of sleep, should be reported immediately.
Choice Multiple question - Select all answer choices that apply. A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. Which of the following are risk factors for cardiovascular problems in clients with hypertension? Choose all that apply. a) Smoking b) Gallbladder disease c) Diabetes mellitus d) Physical inactivity e) Frequent upper respiratory infections
Physical inactivity • Diabetes mellitus • Smoking Explanation: Risk factors for cardiovascular problems in clients with hypertension include smoking, dyslipidemia, diabetes mellitus, impaired renal function, obesity, physical inactivity, age, and family history.
A postoperative client is receiving heparin after developing thrombophlebitis. The nurse monitors the client carefully for bleeding and other adverse effects of heparin. If the client starts to exhibit signs of excessive bleeding, the nurse should expect to administer an antidote that is specific to heparin. Which agent fits this description? a) Thrombin b) Phytonadione (vitamin K) c) Protamine sulfate d) Plasma protein fraction
Protamine sulfate Explanation: Protamine sulfate is the antidote specific to heparin. Phytonadione (vitamin K) is the antidote specific to oral anticoagulants such as warfarin. (Heparin isn't given orally.) Thrombin is a hemostatic agent used to control local bleeding. Plasma protein fraction, a blood derivative, supplies colloids to the blood and expands plasma volume; it's used to treat clients who are in shock.
A female client is readmitted to the facility with a warm, tender, reddened area on her right calf. Which contributing factor should the nurse recognize as most important? a) History of increased aspirin use b) Recent pelvic surgery c) An active daily walking program d) A history of diabetes mellitus
Recent pelvic surgery Explanation: The client shows signs of deep vein thrombosis (DVT). The pelvic area has a rich blood supply, and thrombophlebitis of the deep veins is associated with pelvic surgery. Aspirin, an antiplatelet agent, and an active walking program help decrease the client's risk of DVT. In general, diabetes mellitus is a contributing factor associated with peripheral vascular disease.
A patient is brought to the emergency department with complaints of a bad headache and an increase in blood pressure. The blood pressure reading obtained by the nurse is 260/180 mm Hg. What is the therapeutic goal for reduction of the mean blood pressure? a) Reduce the blood pressure to about 140/80 mm Hg. b) Reduce the blood pressure by 50% within the first hour of treatment. c) Rapidly reduce the blood pressure so the patient will not suffer a stroke. d) Reduce the blood pressure by 20% to 25% within the first hour of treatment.
Reduce the blood pressure by 20% to 25% within the first hour of treatment. Explanation: A hypertensive emergency is a situation in which blood pressures are extremely elevated and must be lowered immediately (not necessarily to less than 140/90 mm Hg) to halt or prevent damage to the target organs (Chobanian et al., 2003; Rodriguez et al., 2010). Hypertensive emergencies are acute, life-threatening blood pressure elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. The therapeutic goals are reduction of the mean blood pressure by 20% to 25% within the first hour of treatment, a further reduction to a goal pressure of about 160/100 mm Hg over a period of up to 6 hours, and then a more gradual reduction in pressure over a period of days.
A client is admitted to the ICU with a diagnosis of heart failure. The client is exhibiting symptoms of weakness, ascites, weight gain, and jugular vein distention. The nurse would know that the client is exhibiting signs of what kind of heart failure? a) Left-sided heart failure b) Chronic heart failure c) Acute heart failure d) Right-sided heart failure
Right-sided heart failure Explanation: Signs and symptoms of Right Ventricular Failure include: Weakness; Ascites; Weight gain; Nausea, vomiting; Dysrhythmias; Elevated central venous pressure; Jugular vein distention. The scenario does not indicate whether the heart failure is chronic or acute. Therefore, options A, B, and C are incorrect.
A physician admits a client to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, which goal should the nurse keep in mind as she formulates interventions? a) Stabilizing heart rate and blood pressure and easing anxiety b) Decreasing blood pressure and increasing mobility c) Increasing blood pressure and monitoring fluid intake and output d) Increasing blood pressure and reducing mobility
Stabilizing heart rate and blood pressure and easing anxiety Explanation: For a client with an aneurysm, nursing interventions focus on preventing aneurysm rupture by stabilizing heart rate and blood pressure. Easing anxiety also is important because anxiety and increased stimulation may raise the heart rate and boost blood pressure, precipitating aneurysm rupture. The client with an abdominal aortic aneurysm is typically hypertensive, so the nurse should take measures to lower blood pressure, such as administering antihypertensive agents, as ordered, to prevent aneurysm rupture. To sustain major organ perfusion, the client should maintain a mean arterial pressure of at least 60 mm Hg. Although the nurse must assess each client's mobility individually, most clients need bed rest when initially attempting to gain stability.
A nurse and physician are preparing to visit a hospitalized client with perepheral arterial disease. As you approach the client's room, the physician asks if the client has reported any intermittent claudication. The client has reported this symptom. The nurse explains to the physician which of the following details? a) The client experiences shortness of breath after walking about 50 feet. b) The client's fingers tingle when left in one position for too long. c) The client can walk about 50 feet before getting pain in the right lower leg. d) The client's legs awaken him during the night with itching.
The client can walk about 50 feet before getting pain in the right lower leg. Explanation: Intermittent claudication is caused by the inability of the arterial system to provide adequate blood flow to the tissues when increased demands are made for oxygen and nutrients during exercise. Pain is then experienced. When the client rests and decreases demands, the pain subsides. The client can then walk the same distance and repeat the process.
The client is admitted for a scheduled cardiac catheterization. On the morning of the procedure, while assessing the client's morning laboratory values, the nurse notes a blood urea nitrogen (BUN) of 34 mg/dL and a creatinine of 4.2 mg/dL. The nurse makes it a priority to notify the physician for which of the following reasons? a) The client is over-hydrated, which puts him at risk for heart failure during the procedure. b) The client is at risk for bleeding. c) These values show a risk for dysrhythmias. d) The client is at risk for renal failure due to the contrast agent that will be given during the procedure.
The client is at risk for renal failure due to the contrast agent that will be given during the procedure. Explanation: The contrast medium must be excreted by the kidneys. If there is already a degree of renal impairment (which these laboratory values indicate), the risk for contrast agent-induced nepropathy and renal failure is high.
The nurse is caring for a patient with venous insufficiency. What should the nurse assess the patient's lower extremities for? a) Cellulitis b) Ulceration c) Dermatitis d) Rudor
Ulceration Explanation: Venous ulceration is the most serious complication of chronic venous insufficiency and can be associated with other conditions affecting the circulation of the lower extremities. Cellulitis or dermatitis may complicate the care of chronic venous insufficiency and venous ulcerations.
When a patient who has been diagnosed with angina pectoris complains that he is experiencing chest pain more frequently even at rest, the period of pain is longer, and it takes less stress for the pain to occur, the nurse recognizes that the patient is describing which type of angina? a) Refractory b) Unstable c) Intractable d) Variant
Unstable Explanation: Unstable angina is also called crescendo or preinfarction angina and indicates the need for a change in treatment. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment. Variant angina is described as pain at rest with reversible ST-segment elevation and is thought to be caused by coronary artery vasospasm. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment.
During electrical cardioversion, the defibrillator is set to synchronize with the ECG so that the electrical impulse discharges during a) ventricular depolarization. b) atrial depolarization. c) ventricular repolarization. d) the QT interval.
ventricular depolarization. Explanation: In cardioversion, the defibrillator is set to synchronize with the ECG on the cardiac monitor so that the electrical impulse discharges during ventricular depolarization.
Which of the following is the most common site for a dissecting aneurysm? a) Sacral area b) Lumbar area c) Thoracic area d) Cervical area
Thoracic area Explanation: The thoracic area is the most common site for a dissecting aneurysm. About one-third of patients with thoracic aneurysms die of rupture of the aneurysm.
A 24-year-old obese woman describes her symptoms of palpitations, chronic fatigue, and dyspnea on exertion to the cardiologist. Upon completing the examination, the cardiologist schedules a procedure to confirm his suspected diagnosis. What diagnostic would you expect him to prescribe? a) Electrocardiography b) Radionuclide angiography c) Transesophageal echocardiography d) Chest radiograph
Transesophageal echocardiography Explanation: TEE involves passing a tube with a small transducer internally from the mouth to the esophagus to obtain images of the posterior heart and its internal structures from the esophagus, which lies behind the heart. TEE provides superior views that are not possible using standard transthoracic echocardiography. Clients whose chests are rotund or who are obese are candidates for TEE. Chest radiography and fluoroscopy determine the size and position of the heart and condition of the lungs. The radionuclide technetium-99m is used to detect areas of myocardial damage. The radionuclide thallium-201 is used to diagnose ischemic heart disease during a stress test. Electrocardiography (ECG) is the graphic recording of the electrical currents generated by the heart muscle. (
The nurse understands that which of the following medications will be administered for 6 to 12 weeks following prosthetic porcine valve surgery? a) Digoxin b) Aspirin c) Warfarin d) Furosemide
Warfarin Explanation: To reduce the risk of thrombosis in patients with porcine or bovine tissue valves, warfarin is required for 6 to 12 weeks, followed by aspirin therapy. Furosemide would not be given for 6 to 12 weeks following this type of surgery. Digoxin may be used for the treatment of arrhythmias, but not just for 6 to 12 weeks
During a teaching session, a client who is having a valuloplasty tomorrow asks the nurse about the difference between a mechanical valve replacement and a tissue valve. Which of the following answers from the nurse is correct information? a) "A mechanical valve is thought to be more durable and so requires replacement less often." b) "Mechanical valves are not always available and are very expensive." c) "Mechanical valves are used for women of childbearing age." d) "A mechanical valve is less likely to generate blood clots, so long-term anticoagulation therapy is not required."
a")A mechanical valve is thought to be more durable and so requires replacement less often." Explanation: Mechanical valves are thought to be more durable than tissue valves and so require replacement less often. Tissue valves are less likely to generate blood clots and so long-term anticoagulation therapy is not required. Homografts (human valves) are not always available and are very expensive.
While assessing a patient with pericarditis, the nurse cannot auscultate a friction rub. Which action should the nurse implement? a) Ask the patient to lean forward and listen again. b) Notify the health care provider. c) Document that the pericarditis has resolved. d) Prepare to insert a unilateral chest tube.
a)Ask the patient to lean forward and listen again. Explanation: The most characteristic sign of pericarditis is a creaky or scratchy friction rub heard most clearly at the left lower sternal border. Having the patient lean forward and to the left uses gravity to force the heart nearer to the chest wall, which allows the friction rub to be heard. These assessment data are not life-threatening and do not require a call to the health care provider. The nurse should try multiple times to auscultate the friction rub before deciding that the rub is gone. Chest tubes are not the treatment of choice for not hearing friction rubs.
Choice Multiple question - Select all answer choices that apply. A nurse is teaching about risk factors that increase the probability of heart disease to a community group. Which of the following risk factors will the nurse include? Choose all that apply. a) Age greater than 45 years for men b) Body mass index (BMI) of 23 c) African-American descent d) Elevated C-reactive protein e) Family history of coronary heart disease
• Elevated C-reactive protein • African-American descent • Family history of coronary heart disease • Age greater than 45 years for men Explanation: Risk factors for coronary heart disease (CHD) include family history of CHD, age older than 45 years for men and 65 years for women, African-American race, BMI of 25 or greater, and elevated C-reactive protein.
A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when he makes which statement? a) "I sleep on three pillows each night." b) "My pants don't fit around my waist." c) "My feet are bigger than normal." d) "I don't have the same appetite I used to."
"I sleep on three pillows each night." Explanation: Orthopnea is a classic sign of left-sided heart failure. The client commonly sleeps on several pillows at night to help facilitate breathing. Swollen feet, ascites, and anorexia are signs of right-sided heart failure.
A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. Which client statement indicates to the nurse a need for additional teaching? a) "I'll enroll in an aerobic exercise program." b) "I should eat foods rich in protein." c) "I can still drink coffee and tea." d) "I should increase my fluid intake."
"I can still drink coffee and tea." Explanation: The client requires more teaching if he states that he may drink coffee and tea. Caffeine is a stimulant, which can exacerbate palpitations, and should be avoided by a client with symptomatic mitral valve prolapse. High fluid intake helps maintain adequate preload and cardiac output. Aerobic exercise helps increase cardiac output and decrease heart rate. Protein-rich foods aren't restricted but high-calorie foods are.
The nurse admits a 52-year-old woman with a medical diagnosis of "rule out MI." The client is very frightened and expresses surprise that a woman would have heart problems. Which of the following responses by the nurse would be most appropriate? a) "A woman's resting heart rate is lower than a man's." b) "The stroke volume from a woman's heart is lower than from a man's heart." c) "It takes longer for an electrical impulse to travel from the sinoatrial node to the atrioventricular node." d) "A woman's heart is smaller and has smaller arteries that become occluded more easily."
"A woman's heart is smaller and has smaller arteries that become occluded more easily." Explanation: Because the coronary arteries of a woman are smaller, they become occluded from atherosclerosis more easily. In addition, the resting rate, stroke volume, and ejection fraction of a woman's heart are higher than those of a man.
A client diagnosed with hypertension begins drug therapy using an antihypertensive agent. The nurse instructs the client's spouse to remove any objects in the home that can lead to falls. The nurse knows that the teaching has been successful when the client restates which of the following? a) "Insomnia is a common side effect of antihypertensive medications." b) "Antihypertensive drugs can lead to falls." c) "Constant thirst is a common side effect of antihypertensive therapy." d) "Antihypertensives can lead to memory loss."
"Antihypertensive drugs can lead to falls." Explanation: One of the side effects of all antihypertensive drugs is hypotension, which can lead to falls. A major concern regarding side effects of all antihypertensive drugs is hypotension, which can lead to falls.
A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the ordered cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction? a) "Client performs relaxation exercises three times per day to reduce stress." b) "Client's 24-hour dietary recall reveals low intake of fat and cholesterol." c) "Client verbalizes an understanding of the need to seek emergency help if his heart rate increases markedly while at rest." d) "Client walks 4 miles in 1 hour every day."
"Client walks 4 miles in 1 hour every day." Explanation: Four weeks after an MI, a client's walking program should aim for a goal of 2 miles in less than 1 hour. Walking 4 miles in 1 hour is excessive and may induce another MI by increasing the heart's oxygen demands. Therefore, this client requires appropriate exercise guidelines and precautions. Performing relaxation exercises; following a low-fat, low-cholesterol diet; and seeking emergency help if the heart rate increases markedly at rest indicate understanding of the cardiac rehabilitation program. For example, the client should reduce stress, which speeds the heart rate and thus increases myocardial oxygen demands. Reducing dietary fat and cholesterol intake helps lower risk of atherosclerosis. A sudden rise in the heart rate while at rest warrants emergency medical attention because it may signal a life-threatening arrhythmia and increase myocardial oxygen demands.
The nurse is reviewing discharge instructions with a patient who underwent a left groin cardiac catheterization 8 hours ago. Which of the following instructions should the nurse include? a) "Contact your primary care provider if you develop a temperature above 102°F." b) "If any discharge occurs at the puncture site, call 911 immediately." c) "Do not bend at the waist, strain, or lift heavy objects for the next 24 hours." d) "You can take a tub bath or a shower when you get home."
"Do not bend at the waist, strain, or lift heavy objects for the next 24 hours." Explanation: The nurse should instruct the patient to complete the following: If the artery of the groin was used, for the next 24 hours, do not bend at the waist, strain, or lift heavy objects; the primary provider should be contacted if any of the following occur: swelling, new bruising or pain from your procedure puncture site, temperature of 101°F or more. If bleeding occurs, lie down (groin approach) and apply firm pressure to the puncture site for 10 minutes. Notify the primary provider as soon as possible and follow instructions. If there is a large amount of bleeding, call 911. The patient should not drive to the hospital.
Two nursing students are reading EKG strips. One of the students asks the instructor what the P-R interval represents. The correct response should be which of the following? a) "It shows the time it takes the AV node impulse to depolarize the atria and travel through the SA node." b) "It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." c) "It shows the time it takes the AV node impulse to depolarize the septum and travel through the Purkinje fibers." d) "It shows the time it takes the AV node impulse to depolarize the ventricles and travel through the SA node."
"It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." Explanation: The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex and represents the time needed for sinus node stimulation, atrial depolarization, and conduction through the AV node before ventricular depolarization. In a normal heart the impulses do not travel backward. The PR interval does not include the time it take to travel through the Purkinje fibers.
The nurse in a cardiac clinic is taking vital signs of a 58-year-old man who is 3 months status post myocardial infarction (MI). While the physician is seeing the client, the client's spouse approaches the nurse and asks about sexual activity. "We are too afraid he will have another heart attack, so we just don't have sex anymore." The nurse's best response is which of the following? a) "It is usually better to just give up sex after a heart attack." b) "The physiologic demands are greatest during orgasm and are equivalent to walking 3 to 4 miles per hour on a treadmill." c) "The medications will prevent your husband from having an erection." d) "Having an orgasm is very strenuous and your husband must be in excellent physical shape before attempting it."
"The physiologic demands are greatest during orgasm and are equivalent to walking 3 to 4 miles per hour on a treadmill." Explanation: The physiologic demands are greatest during orgasm. The level of activity is equivalent to walking 3 to 4 miles per hour on a treadmill. Erectile dysfunction may be a side effect of beta-blockers, but other medications may be substituted.
A nurse is teaching a patient about valve replacement surgery. Which statement by the patient indicates an understanding of the benefit of an autograft replacement valve? a) "The valve is from a tissue donor, and I will not need to take any blood thinning drugs with I am discharged." b) "The valve is made from a pig tissue, and I will not need to take any blood-thinning drugs when I am discharged." c) "The valve is made from my own heart valve, and I will not need to take any blood thinning drugs when I am discharged." d) "The valve is mechanical, and it will not deteriorate or need replacing."
"The valve is made from my own heart valve, and I will not need to take any blood thinning drugs when I am discharged." Explanation: Autografts (i.e., autologous valves) are obtained by excising the patient's own pulmonic valve and a portion of the pulmonary artery for use as the aortic valve. Anticoagulation is unnecessary because the valve is the patient's own tissue and is not thrombogenic. The autograft is an alternative for children (it may grow as the child grows), women of childbearing age, young adults, patients with a history of peptic ulcer disease, and people who cannot tolerate anticoagulation. Aortic valve autografts have remained viable for more than 20 years.
A nursing student is caring for one of the nurse's assigned cardiac clients. The student asks, "How can I tell the difference between ventricular tachycardia and ventricular fibrillation when I look at the EKG strip?" The best reply by the nurse is which of the following? a) "Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast with wide QRS complexes." b) "The two look very much alike; it is difficult to tell the difference." c) "The P-R interval will be prolonged in ventricular fibrillation, while in ventricular tachycardia the P-R interval is normal." d) "The QRS complex in ventricular fibrillation is always narrow, while in ventricular tachycardia, the QRS is of normal width."
"Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast with wide QRS complexes." Explanation: Ventricular fibrillation is irregular with undulating waves and no QRS complex, while ventricular tachycardia is usually regular and fast with wide QRS complexes.
The nurse is assisting a patient with peripheral arterial disease to ambulate in the hallway. What should the nurse include in the education of the patient during ambulation? a) "If you feel any discomfort, stop and we will use a wheelchair to take you back to your room." b) "Walk to the point of pain, rest until the pain subsides, then resume ambulation." c) "As soon as you feel pain, we will go back and elevate your legs." d) "If you feel pain during the walk, keep walking until the end of the hallway is reached."
"Walk to the point of pain, rest until the pain subsides, then resume ambulation." Explanation: The nurse instructs the patient to walk to the point of pain, rest until the pain subsides, and then resume walking so that endurance can be increased as collateral circulation develops. Pain can serve as a guide in determining the appropriate amount of exercise.
In order to be effective, percutaneous transluminal coronary angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction? a) 6 to 12 months b) 30 minutes c) 9 days d) 60 minutes
60 minutes Explanation: The 60-minute interval is known as "door-to-balloon time" for performance of PTCA on a diagnosed MI patient. The 30-minute interval is known as "door-to-needle time" for administration of thrombolytics post MI. The time frame of 9 days refers to the time for onset of vasculitis after administration of streptokinase for thrombolysis in an acute MI patient. The 6 to 12 month time frame refers to the time period during which streptokinase will not be used again in the same patient for acute MI.
A nurse has come upon an unresponsive, pulseless victim. She has placed a 911 call and begins CPR. The nurse understands that if the patient has not been defibrillated within which time frame, the chance of survival is close to zero? a) 10 minutes b) 20 minutes c) 15 minutes d) 25 minutes
10 minutes Explanation: The survival rate decreases for every minute that defibrillation is delayed. If the patient has not been defibrillated within 10 minutes, the chance of survival is close to zero. The other options are too long of a time frame.
A patient who had a prosthetic valve replacement was taking Coumadin to reduce the risk of postoperative thrombosis. He visited the nurse practitioner at the Coumadin clinic once a week. Select the INR level that would alert the nurse to notify the health care provider. a) 3.0 b) 3.8 c) 3.4 d) 2.6
3.8 Explanation: Coumadin patients usually have individualized target international normalized ratios (INRs) between 2 to 3.5 to maintain adequate anticoagulation. Levels below 2 to 2.5 can result in insufficient anticoagulation and levels greater than 3.5 can result in dangerous and prolonged anticoagulation.
Post-cardiac surgery assessment of renal function should be performed hourly for the first 12 to 24 hours. Identify the laboratory result that the nurse knows is a primary indicator of possible renal failure. a) A serum creatinine of 1.0 mg/dL b) A urine specific gravity reading of 1.021 c) A serum BUN of 70 mg/dL d) An hourly urine output of 50 to 70 mL
A serum BUN of 70 mg/dL Explanation: These four laboratory results should always be assessed, post cardiac surgery. Serum osmolality (N = >800 mOsm/kg) should also be included. A BUN reading of greater than 21 mg/dL is abnormal; a reading of greater than 60 mg/dL is indicative of renal failure. The lab results in the other choices are all within normal range.
A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do? a) Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician. b) Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin. c) Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team. d) Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs.
Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin. Explanation: Cardiac chest pain is caused by myocardial ischemia. Therefore the nurse should administer supplemental oxygen to increase the myocardial oxygen supply, attach a cardiac monitor to help detect life-threatening arrhythmias, and take vital signs to ensure that the client isn't hypotensive before giving sublingual nitroglycerin for chest pain. Registration information may be delayed until the client is stabilized. Alerting the cardiac catheterization team or the physician before completing the initial assessment is premature.
A total artificial heart (TAH) is an electrically powered pump that circulates blood into the pulmonary artery and the aorta, thus replacing the functions of both the right and left ventricles. What makes it different from an LVAD? a) It never needs batteries. b) It's designed for extremely active patients. c) It's specifically designed for long-term use. d) An LVAD only supports a failing left ventricle.
An LVAD only supports a failing left ventricle. Explanation: A TAH is considered an extension of LVADs, which only support a failing left ventricle. TAHs are targeted for clients who are unlikely to live more than a month without further interventions.
The nurse in the intensive care unit (ICU) hears an alarm sound in the patient's room. Arriving in the room, the patient is unresponsive, without a pulse, and a flat line on the monitor. What is the first action by the nurse? a) Administer atropine 0.5 mg b) Administer epinephrine c) Defibrillate with 360 joules (monophasic defibrillator) d) Begin cardiopulmonary resuscitation (CPR)
Begin cardiopulmonary resuscitation (CPR) Explanation: Commonly called flatline, ventricular asystole (Fig. 26-19) is characterized by absent QRS complexes confirmed in two different leads, although P waves may be apparent for a short duration. There is no heartbeat, no palpable pulse, and no respiration. Without immediate treatment, ventricular asystole is fatal. Ventricular asystole is treated the same as PEA, focusing on high-quality CPR with minimal interruptions and identifying underlying and contributing factors.
A nurse is providing morning care for a patient in the ICU. Suddenly, the bedside monitor shows ventricular fibrillation and the patient becomes unresponsive. After calling for assistance, what action should the nurse take next? a) Administer intravenous epinephrine. b) Prepare for endotracheal intubation. c) Provide electrical cardioversion. d) Begin cardiopulmonary resuscitation.
Begin cardiopulmonary resuscitation. Explanation: In the acute care setting, when ventricular fibrillation is noted, the nurse should call for assistance and defibrillate the patient as soon as possible. If defibrillation is not readily available, CPR is begun until the patient can be defibrillated, followed by advanced cardiovascular life support (ACLS) intervention, which includes endotracheal intubation and administration of epinephrine. Electrical cardioversion is not indicated for a patient in ventricular fibrillation.
When treating hypertensive emergencies, the nurse identifies the most appropriate route of administration for antihypertensive agents as being which of the following? a) Intramuscular b) Sublingual c) Oral d) Continuous IV infusion
Continuous IV infusion Explanation: The medications of choice in hypertensive emergencies are best managed through the continuous IV infusion of a short-acting titratable antihypertensive agent. The nurse avoids the sublingual and IM routes as their absorption and dynamics are unpredictable. The oral route would not have as quick an onset as a continuous IV infusion.
The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block? a) P waves hidden with the QRS complex b) An irregular rhythm c) Delayed conduction, producing a prolonged PR interval d) A variable heart rate, usually fewer than 60 bpm
Delayed conduction, producing a prolonged PR interval Explanation: First-degree AV block occurs when all the atrial impulses are conducted through the AV node into the ventricles at a rate slower than normal. Thus the PR interval is prolonged (>0.20 seconds).
The nursing instructor is discussing heart failure with their clinical group. The instructor talks about heart failure in terms of a decreasing ejection fraction of the heart. What diagnostic test is used to measure the ejection fraction of the heart? a) MRI b) Nuclear angiography c) Echocardiogram d) Pulmonary arterial pressure
Echocardiogram Explanation: The heart's ejection fraction is measured using an echocardiogram or multiple gated acquisition scan. An MRI, pulmonary arterial pressure, and nuclear angiography do not give diagnostic information about the hearts' ejection fraction.
A patient is exhibiting digitalis toxicity. Which of the following medications would the nurse expect to be ordered for this patient? a) Amlodipine (Norvasc) b) Digoxin immune FAB (Digibind) c) Ibuprofen (Motrin) d) Warfarin (Coumadin)
Digoxin immune FAB (Digibind) Explanation: Digibind binds with digoxin and makes it unavailable for use. The Digibind dosage is based on the digoxin level and the patient's weight. Motrin, Coumadin, and Norvasc are not used to reverse the effects of digoxin.
The nurse performing an assessment on a patient who has arterial insufficiency of the legs and an ulcer on the left great toe would expect to find which of the following characteristics? a) Pulses are present, may be difficult to palpate b) Diminished or absent pulses c) Aching, cramping pain d) Superficial ulcer
Diminished or absent pulses Explanation: Occlusive arterial disease impairs blood flow and can reduce or obliterate palpable pulsations in the extremities. A diminished or absent pulse is a characteristic of arterial insufficiency.
A client is diagnosed with peripheral arterial disease. Review of the client's chart shows an ankle-brachial index (ABI) on the right of 0.45. This indicates that the right foot has which of the following? a) Very mild arterial insufficiency b) No arterial insufficiency c) Tissue loss to that foot d) Moderate to severe arterial insufficiency
Moderate to severe arterial insufficiency Explanation: Normal people without arterial insufficiency have an ABI of about 1.0. Those with an ABI of 0.95 to 0.5 have mild to moderate arterial insufficiency. Those with an ABI of less than 0.50 have ischemic rest pain. Those with tissue loss have severe ischemia and an ABI of 0.25 or less.
Which signs and symptoms accompany a diagnosis of pericarditis? a) Lethargy, anorexia, and heart failure b) Pitting edema, chest discomfort, and nonspecific ST-segment elevation c) Low urine output secondary to left ventricular dysfunction d) Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR)
Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) Explanation: The classic signs and symptoms of pericarditis include fever, positional chest discomfort, nonspecific ST-segment elevation, elevated ESR, and pericardial friction rub. Low urine output secondary to left ventricular dysfunction lethargy, anorexia, heart failure and pitting edema, result from acute renal failure.
Which of the following nursing interventions must a nurse perform when administering prescribed vasopressors to a patient with a cardiac dysrhythmia? a) Document heart rate before and after administration b) Keep the patient flat for one hour after administration c) Administer every five minutes during cardiac resuscitation d) Monitor vital signs and cardiac rhythm
Monitor vital signs and cardiac rhythm Explanation: The nurse should monitor the patient's vital signs and cardiac rhythm for effectiveness of the medication and for side effects and should always have emergency life support equipment available when caring for an acutely ill patient. The side effects of vasopressor drugs are hypertension, dysrhythmias, pallor, and oliguria. It is not necessary to place a patient flat during or after vasopressor administration. When administering cholinergic antagonists, documentation of the heart rate is necessary.
A nurse is monitoring the vital signs and blood results of a 53-year-old male patient who is receiving anti-coagulation therapy. Which of the following does the nurse identify as a major indication of concern? a) Hemoglobin of 16 g/dL b) Heart rate of 87 bpm c) Blood pressure of 129/72 mm Hg d) Hematocrit of 30%
Hematocrit of 30% Explanation: Hematocrit is a measurement of the proportion of blood volume that is occupied by red blood cells. A lowered hematocrit can imply internal bleeding.
The nurse expects to see which of the following characteristics on an ECG strip for a patient who has third-degree AV block? a) Shortened QRS duration. b) Atrial rate of 60 bpm or below c) More P waves than QRS complexes d) Extended PR interval
More P waves than QRS complexes Explanation: There is no PR interval because there isn't any relationship between the P and R wave. No atrial impulse is conducted through the AV node; atrial and ventricular contractions are independent. With third-degree AV block, two separate impulses stimulate the heart; there is no synchrony or relationship.
In a client with chronic bronchitis, which sign would lead the nurse to suspect right-sided heart failure? a) Leg edema b) Cyanosis of the lips c) Bilateral crackles d) Productive cough
Leg edema Explanation: Right-sided heart failure is characterized by signs of circulatory congestion, such as leg edema, jugular vein distention, and hepatomegaly. Left-sided heart failure is characterized by circumoral cyanosis, crackles, and a productive cough
The nurse is administering a beta blocker to a patient in order to decrease automaticity. Which medication will the nurse administer? a) Rythmol b) Cordarone c) Cardizem d) Lopressor
Lopressor Explanation: Patients may receive beta-blockers prior to the scan to control heart rate and rhythm
After a physical examination, the provider diagnosed a patient with a grade 4 heart murmur. During assessment, the nurse expects to hear a murmur that is: a) Quiet but readily heard. b) Very loud; can be heard with the stethoscope half-way off the chest. c) Loud and may be associated with a thrill sound similar to (a purring cat). d) Easily heard with no palpable thrill.
Loud and may be associated with a thrill sound similar to (a purring cat). Correct Explanation: Heart murmurs are characterized by location, timing, and intensity. A grading system is used to describe the intensity or loudness of a murmur. A grade 1 is very faint and difficult to describe, whereas a grade 6 is extremely loud. Refer to Box 12-3 in the text for a description of grades 1 to 6.
The nurse is caring for a patient with peripheral arterial insufficiency. What can the nurse suggest to help relieve leg pain during rest? a) Massaging the limb after application of cold compresses b) Placing the limb in a plane horizontal to the body c) Lowering the limb so that it is dependent d) Elevating the limb above heart level
Lowering the limb so that it is dependent Explanation: Persistent pain in the forefoot (i.e., the anterior portion of the foot) when the patient is resting indicates a severe degree of arterial insufficiency and a critical state of ischemia. Known as rest pain, this discomfort is often worse at night and may interfere with sleep. This pain frequently requires that the extremity be lowered to a dependent position to improve perfusion to the distal tissues.
A 6-year-old female client is admitted to the pediatrics unit due to suspected rheumatic fever. Aggressive antibiotic therapy and comfort measures have been instituted to minimize the long-lasting effects of the systemic inflammation. If the client were to develop rheumatic carditis, which cardiac structure would most likely be affected? a) Inferior vena cava b) Septum c) Mitral valve d) Coronary arteries
Mitral valve Explanation: In rheumatic carditis, cardiac structures that usually are affected include the heart valves (particularly the mitral valve), endocardium, myocardium, and pericardium. In rheumatic carditis, cardiac structures that usually are affected include the heart valves (particularly the mitral valve), endocardium, myocardium, and pericardium. In rheumatic carditis, cardiac structures that usually are affected include the heart valves (particularly the mitral valve), endocardium, myocardium, and pericardium. In rheumatic carditis, cardiac structures that usually are affected include the heart valves (particularly the mitral valve), endocardium, myocardium, and pericardium.
A patient at the clinic describes shortness of breath, periods of feeling "lightheaded," and feeling fatigued despite a full night's sleep. The nurse obtains vital signs and auscultates a systolic click. What does the nurse suspect from the assessment findings? a) Mitral valve prolapse b) Mitral regurgitation c) Aortic stenosis d) Aortic regurgitation
Mitral valve prolapse Explanation: Most people with mitral valve prolapse never have symptoms. A few have fatigue, shortness of breath, lightheadedness, dizziness, syncope, palpitations, chest pain, or anxiety. Fatigue may occur regardless of activity level and amount of rest or sleep. Often the first and only sign of mitral valve prolapse is an extra heart sound, referred to as a mitral click. A systolic click is an early sign that a valve leaflet is ballooning into the left atrium.
The nurse is analyzing a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0.18 seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as which of the following? a) Normal sinus rhythm b) First-degree atrioventricular (AV) block c) Junctional tachycardia d) Sinus tachycardia
Normal sinus rhythm Explanation: The ECG tracing shows normal sinus rhythm (NSR). NSR has the following characteristics: ventricular and atrial rate: 60 to 100 beats per minute (bpm) in the adult; ventricular and atrial rhythm: regular; and QRS shape and duration: usually normal, but may be regularly abnormal; P wave: normal and consistent shape, always in front of the QRS; PR interval: consistent interval between 0.12 and 0.20 seconds and P:QRS ratio: 1:1.
A systolic blood pressure of 135 mm Hg would be classified as which of the following? a) Stage 1 hypertension b) Normal c) Prehypertension d) Stage 2 hypertension
Prehypertension Explanation: A systolic blood pressure of 135 mm Hg is classified as prehypertension. A systolic BP of less than 120 mm Hg is normal. A systolic BP of 140 to 159 mm Hg is stage I hypertension. A systolic BP of greater than or equal to 160 is classified as stage 2 hypertension.
The nurse is part of a triage team that is assessing a patient to determine if his chest pain is a manifestation of angina pectoris or an MI. The nurse knows that a primary distinction is that the pain of angina is: a) Described as crushing and substernal b) Accompanied by diaphoresis and dyspnea c) Relieved by rest and nitroglycerin d) Associated with nausea and vomiting
Relieved by rest and nitroglycerin Explanation: One characteristic that can differentiate the pain of angina from a myocardial infarction is pain that is relieved by rest and nitroglycerine. There may be some exceptions (unstable angina), but the distinction is helpful especially when combined with other assessment data.
A physician orders blood coagulation tests to evaluate a client's blood-clotting ability. The nurse knows that such tests are important in assessing clients at risk for thrombi, such as those with a history of atrial fibrillation, infective endocarditis, prosthetic heart valves, or myocardial infarction. Which test determines a client's response to oral anticoagulant drugs? a) Partial thromboplastin time (PTT) b) Bleeding time c) Platelet count d) Prothrombin time (PT)
Prothrombin time (PT) Explanation: PT determines a client's response to oral anticoagulant therapy. This test measures the time required for a fibrin clot to form in a citrated plasma sample following addition of calcium ions and tissue thromboplastin and compares this time with the fibrin-clotting time in a control sample. The physician should adjust anticoagulant dosages as needed, to maintain PT at 1.5 to 2.5 times the control value. Bleeding time indicates how long it takes for a small puncture wound to stop bleeding. The platelet count reflects the number of circulating platelets in venous or arterial blood. PTT determines the effectiveness of heparin therapy and helps physicians evaluate bleeding tendencies. Physicians diagnose appoximately 99% of bleeding disorders on the basis of PT and PTT values.
Part of the continued management of a patient with infective endocarditis is assessment for the presence of Janeway lesions. On inspection, the nurse recognizes these lesions by identifying which characteristic sign? a) Patterns of petechiae on the chest b) Splinter hemorrhages seen under the fingernails c) Red or purple macules found on the palms of the hands d) Erythematosus modules on the pads of the fingers
Red or purple macules found on the palms of the hands Explanation: Janeway lesions are painless, red or purple macules found on the palms and soles.
A nurse is caring for a 30-year-old client diagnosed with atrial fibrillation who has just had a mitral valve replacement. The client is being discharged with prescribed warfarin (Comaudin). She mentions to you that she relies on the rhythm method for birth control. What education would be a priority for the nurse to provide to this client? a) Instructions for using the rhythm method b) Symptoms to report of worsening tachycardia related to atrial fibrillation c) Foods to limit (green leafy vegetables) while taking warfarin d) The high risk for complications if she becomes pregnant while taking warfarin
The high risk for complications if she becomes pregnant while taking warfarin Explanation: Women of childbearing age should not take warfarin (pregnancy X category) if they plan to become pregnant. There is danger to the placenta and risk for the mother to bleed. The fetus may also be affected. This client should practice a more reliable method of birth control.
The patient has had biomarkers drawn after complaining of chest pain. Which diagnostic of myocardial infarction remains elevated for as long as 3 weeks? a) Troponin b) CK-MB c) Total CK d) Myoglobin
Troponin remains elevated for a long period, often as long as 3 weeks, and it therefore can be used to detect recent myocardial damage. Myoglobin returns to normal in 12 hours. Total CK returns to normal in 3 days. CK-MB returns to normal in 3 to 4 days
A home health nurse is seeing an elderly male client for the first time. During the physical assessment of the skin on the lower legs, the nurse notes edema, brown pigmentation in the gater area, pedal pulses, and a few irregularly shaped ulcers around the ankles. From these findings, the nurse knows that the client has a problem with peripheral circulation. Which of the following does the nurse suspect? a) Venous insufficiency b) Trauma c) Arterial insufficiency d) Neither venous nor arterial insufficiency
Venous insufficiency Explanation: Symptoms of venous insufficiency include present pedal pulses, edema, pigmentation in gater area, and a reddish blue color. Ulcers caused by venous insufficiency will be irregular in shape and usually located around the ankles or the anterior tibial area. Characteristics of arterial insufficiency ulcers include location at the tips of the toes, great pain, and circular shape with a pale to black ulcer base.
A nurse is teaching a client how to take nitroglycerin to treat angina pectoris. The client verbalizes an understanding of the need to take up to three sublingual nitroglycerin (Nitrostat) tablets at 5-minute intervals, if necessary, and to notify the physician immediately if chest pain doesn't subside within 15 minutes. The nurse tells the client that, after taking the nitroglycerin, he may experience: a) sedation, nausea, vomiting, constipation, and respiratory depression. b) headache, hypotension, dizziness, and flushing. c) nausea, vomiting, depression, fatigue, and impotence. d) flushing, dizziness, headache, and pedal edema.
headache, hypotension, dizziness, and flushing. Explanation: Headache, hypotension, dizziness, and flushing are classic adverse effects of nitroglycerin, a vasodilator. Vasodilators, beta-adrenergic blockers, and calcium channel blockers are three major classes of drugs used to treat angina pectoris. Nausea, vomiting, depression, fatigue, and impotence are adverse effects of propranolol, a beta-adrenergic blocker. Sedation, nausea, vomiting, constipation, and respiratory depression are common adverse effects of morphine, an opioid analgesic that relieves pain associated with acute myocardial infarction. Flushing, dizziness, headache, and pedal edema are common adverse effects of nifedipine, a calcium channel blocker.
Premature ventricular contractions (PVCs) are considered precursors of ventricular tachycardia (VT) when they: a) are paired with a normal beat b) occur during the QRS complex c) occur at a rate of more than six per minute d) have the same shape
occur at a rate of more than six per minute Explanation: When PVCs occur at a rate of more than six per minute, they indicate increasing ventricular irritability and are considered forerunners of VT. PVCs are dangerous when they occur on the T wave. PVCs are dangerous when they are multifocal (have different shapes). A PVC that is paired with a normal beat is termed bigeminy.
