Med Surg II
C-reactive protein normal range
0 (only present when there is inflammation)
Prothrombin time (PT) normal range
10-13 seconds
Platelet normal range
150,000-400,000 mc/L
Homocysteine normal range
4.4-10.8 mm/L
What rate can the ventricular pacer cells generate?
40 beats per minute or less
HDL normal range
40-60 mg/dL
Glucose normal range
65-99 mg/dL
What does the P wave represent?
Atrial depolarization
What does the QRS complex represent?
Ventricular depolarization
The nurse prepares to administer which prescribed medication to the patient with shortness of breath and a heart rhythm of 46 beats per minute? a.) Atropine sulfate b.) Atenolol c.) Diltiazem d.) Adenosine
a.) Atropine sulfate
A nurse is teaching a client who is starting to take an ACE inhibitor to treat hypertension. The nurse should instruct the client to notify the provider if he experiences which of the following adverse effects? a.) Tendon pain b.) Persistent cough c.) Frequent urination d.) Constipation
b.) Persistent cough
A nurse is caring for a client who has a history of angina and is scheduled for exercise electrocardiography at 1100. Which of the following statements by the client requires the nurse to contact the provider for possible rescheduling? a.) "I'm still hungry after the bowl of cereal I ate at 7 a.m." b.) "I didn't take my heart pills this morning because the doctor told me not to" c.) "I have had chest pain a couple of times since I saw my doctor in the office last week" d.) "I smoked a cigarette this morning to calm my nerves about having this procedure"
d.) "I smoked a cigarette this morning to calm my nerves about having this procedure"
The nurse is preparing to defibrillate a patient and selects which setting before the first shock? a.) 50 J b.) 100 J c.) 150 J d.) 200 J
d.) 200 J
The nurse is concerned that a patient is at risk for pulseless electrical activity. What information from the assessment did the nurse use to make this clinical decision? a.) Blood pH 7.30 b.) Temperature 100.5 F c.) Serum glucose level 170 mg/dL d.) Serum potassium level 4.1 mEg/L
a.) Blood pH 7.30
A nurse is providing discharge teaching for a client who has a prescription for the transdermal nitroglycerin patch. Which of the following instructions should the nurse include in the teaching? a.) Apply the new patch to the same site as the previous patch b.) Place the patch on an area of skin away from skin folds and joints c.) Keep the patch on 24 hr per day d.) Replace the patch at the onset of angina
b.) Place the patch on an area of skin away from skin folds and joints
The nurse is performing an assessment on a client and comes up with a blood pressure reading of 140/95. The client then states, "my blood pressure has been higher than that the last two times I have checked it". Upon further evaluation, the nurse finds this to be true and knows that the client is experiencing what? a.) Stage 1 hypertension b.) Stage 2 hypertension c.) Nothing, this blood pressure reading is normal.
b.) Stage 2 hypertension
What rate can the purkinje fibers generate?
20 beats per minute or less
What are some causes of pulseless electrical activity?
Acidosis Hypothermia Hypoglycemia Hyper- or hypokalemia
What is depolarization?
Contraction of the heart
What are some major risk factors for cardiovascular disease?
Family history of cardiovascular disease Diabetes mellitus Chronic renal disease Hypertension Dyslipidemia
What cause friction rub?
Pericarditis
Signs associated with left sided heart failure
SOB Dyspnea Orthopnea Crackles on auscultation Weak pulses Slow capillary refill Cool temperature in extremities Fatigue, weakness
What are some symptoms of heart failure?
SOB Fatigue Swelling in feet, ankles, legs and abdomen
What does the T wave represent?
Ventricular repolarization
A nurse is caring for a client who is scheduled for a coronary artery bypass graft in 2 hr. Which of the following client statements indicates a need for further clarification by the nurse? a.) "My arthritis is really bothering me because I haven't taken my aspirin in a week" b.) "My blood pressure shouldn't be high because I took my blood pressure medication this morning" c.) "I took my warfarin last night according to my usual schedule" d.) "I will check my blood sugar because I took a reduced dose of insulin this morning"
c.) "I took my warfarin last night according to my usual schedule"
A patient's heart rate is 48 beats per minute. The nurse correlates this heart rate to the inherent rate of which structure? a.) Purkinje fibers b.) Sinoatrial node c.) Atrioventricular node d.) Ventricular pacer cells
c.) Atrioventricular node
A nurse is reviewing laboratory results of several male clients who have peripheral arterial disease. The nurse should plan to provide dietary teaching for the client who has which of the following values? a.) Cholesterol 180 mg/dL, HDL 70 mg/dL, LDL 90 mg/dL b.) Cholesterol 185 mg/dL, HDL 50 mg/dL, LDL 120 mg/dL c.) Cholesterol 190 mg/dL, HDL 25 mg/dL, LDL 160 mg/dL d.) Cholesterol 195 mg/dL, HDL 55 mg/dL, LDL 125 mg/dL
c.) Cholesterol 190 mg/dL, HDL 25 mg/dL, LDL 160 mg/dL
A nurse is assessing a client who has a history of deep-vein thrombosis and is receiving warfarin. The nurse should identify that which of the following findings indicates the medication is effective? a.) Hemoglobin 14 g/dl b.) Minimal bruising of extremities c.) Decreased blood pressure d.) INR 2.0
d.) INR 2.0
A nurse is preparing a client for coronary angiography. The nurse should report which of the following findings to the provider prior to the procedure? a.) Hemoglobin 14.4 g/dl b.) History of peripheral arterial disease c.) Urine output 200 mL/4 hr d.) Previous allergic reaction to shellfish
d.) Previous allergic reaction to shellfish
Signs associated with right sided heart failure
Jugular venous distention Dependent edema Ascites
What is the order of electrical impulse through the heart?
1.) SA node fires 2.) Impulse spreads through the atrial myocardium 3.) Impulse travels to the AV node 4.) Impulse leaves the AV node through the bundle of His 5.) Impulse travels through the bundle branches 6.) Impulse extends into the ventricular tissue through the purkinje fibers
Partial thromboplastin time (PTT) normal range
25-35 seconds
What rate can the atrioventricular node generate?
40-60 beats per minute *This is considered the gatekeeper of the heart! If the SA node fails to fire, this is the backup.
What is an angiography?
A left sided cardiac catheterization to inspect the coronary arteries for blockages A catheter is inserted and then contrast dye is inject to visualize the vessels
What is an angioplasty?
A procedure to open a blocked artery A balloon or stent is placed in the vessel at the site of the blockage to restore proper blood flow
What are some symptoms of coronary artery disease?
Angina Pain in the neck, jaw, throat, upper abdomen or back
Digoxin
Class: Cardiac glycoside Action: Slows conduction through the AV node, improves contractility Rhythm: Sinus tachycardia, atrial fibrillation, atrial flutter Monitor: Digoxin levels, renal function Consider: Use cautiously in combination with amiodarone
Adenosine
Class: Antiarrhythmic Action: Slows down the heart rate temporarily Rhythm: Supraventricular tachycardia Monitor: May result in asystole, transcutaneous pacemaker should be readily available!
Amiodarone
Class: Antiarrhythmic Action: Slows the cardiac action potential thus slowing the heart rate Rhythm: Ventricular tachycardia, ventricular fibrillation, atrial fibrillation Monitor: Pulmonary, thyroid and liver function
Atropine
Class: Antiarrhytmic Action: Increases SA node stimulus Rhythm: Sinus bradycardia Consider: Use cautiously with MI patients
What are lab markers of heart disease?
Creatine-kinase myocardial bands (CK-MB) Troponin Myoglobin
Nursing interventions for post-op catheterization
Flat bedrest for 2-6 hours Observation of insertion site for bleeding Frequent vital signs Monitor for chest pain Assess for signs of stroke Monitor peripheral pulses Monitor urine output Maintain sufficient fluid intake Obtain blood work
LDL normal range
Less than 100 mg/dL
Triglyceride normal range
Less than 150 mg/dL
INR normal range
Less than 2.0
Cholesterol normal range
Less than 200 mg/dL
What is a lipid panel?
Measures cholesterol levels and triglycerides
What is important to note when describing heart sounds?
Pitch Quality Intensity Timing Location
What is repolarization?
Resting state of the heart
What is the purpose of a transesophageal echocardiogram (TEE)?
This exam can allow doctors to get a clearer and better picture of the heart. This is most commonly used to see specific structures of the heart or to visualize clots in the heart chambers.
What are some examples of modifiable risk factors?
Weight Dietary habits Alcohol consumption Smoking
A nurse is assessing a client who has left-sided heart failure. Which of the following manifestations should the nurse expect to find? a.) Increased abdominal girth b.) Weak peripheral pulses c.) Jugular venous neck distention d.) Dependent edema
b.) Weak peripheral pulses
A nurse is caring for a client who had an onset of chest pain 24 hr ago. The nurse should recognize that an increase in which of the following is diagnostic of myocardial infarction? a.) Myoglobin b.) C-reactive protein c.) Creatinine kinase-MB d.) Homocysteine
c.) Creatinine kinase-MB
The nurse correlates the P wave on the ECG tracing to which cardiac action? a.) Repolarization of the purkinje fibers b.) Repolarization of the ventricles c.) Depolarization of the atria d.) Depolarization of the ventricles
c.) Depolarization of the atria
The nurse is performing an assessment of the patient's medical history. The nurse knows that which of the following complaints are pertinent to heart disease? (Select all that apply) a.) Chest pain b.) Difficulty breathing c.) Edema d.) Syncope e.) All of the above
e.) All of the above
What rate can the sinoatrial node generate?
60-100 beats per minute *This is considered the pacemaker of the heart!
Epinephrine
Class: Vasopressor Action: Produces vasoconstriction Rhythm: Ventricular tachycardia, ventricular fibrillation Consider: Ensure free-flowing IV, use in combination with CPR
What generates the S2 heart sound? "Dubb"
Close of the aortic and pulmonary valves (Semilunar valves)
What generates the S1 heart sound? "Lubb"
Closure of the tricuspid and mitral valves (AV valves)
A patient is being prepared for a transvenous pacemaker. What should the nurse include when explaining this pacemaker to the family? a.) "It is inserted using an internal jugular vein" b.) "It is done by placing defibrillator pads on the torso using an anterior/posterior position" c.) "It is done by placing a pacer wire in the atrium or the ventricle and fed out through the skin, where it is attached to an external pacemaker" d.) "It is inserted by placing pacer wires in the atrium, ventricle, or both and attached to a small pacemaker generator placed under the skin near the clavicle"
a.) "It is inserted using an internal jugular vein"
A nurse in an emergency department is caring for a client who has a blood pressure of 254/139. The nurse recognizes that the client is in a hypertensive crisis. Which of the following actions should the nurse take first? a.) Initiate seizure precautions b.) Tell the client to report vision changes c.) Elevate the head of the client's bed d.) Start a peripheral IV
c.) Elevate the head of the client's bed
Atenolol, metoprolol, carvedilol, sotalol
Class: Beta blocker Action: Negative chronotropic effects, helps to slow down the heart rate Rhythm: Sinus tachycardia, atrial fibrillation with RVR Consider: Use cautiously in patients with heart failure and asthma
Diltiazem
Class: Calcium channel blocker Action: Slows conduction through the AV node Rhythm: Atrial fibrillation, atrial flutter Consider: Use cautiously in patients with heart failure
A nurse is caring for a client following insertion of a permanent pacemaker. Which of the following client statements indicates a potential complication of the insertion procedure? a.) "I can't get rid of these hiccups" b.) "I feel dizzy when I stand" c.) "My incision site stings" d.) I have a headache"
a.) "I can't get rid of these hiccups"
A nurse is providing teaching for a client who is 2 days postoperative following a heart transplant. Which of the following statements should the nurse include in the teaching? a.) "You might no longer be able to feel chest pain" b.) "Your level of activity intolerance will not change" c.) "After 6 months, you will no longer need to restrict your sodium intake" d.) "You will be able to stop taking immunosuppressants after 12 months"
a.) "You might no longer be able to feel chest pain"
A nurse is assessing a client who has pulmonary edema related to heart failure. Which of the following findings indicates effective treatment of the client's condition? a.) Absence of adventitious breath sounds b.) Presence of a nonproductive cough c.) Decrease in respiratory rate at rest d.) SaO2 86% on room air
a.) Absence of adventitious breath sounds
An older adult client is being evaluated for a new onset of a cardiac dysrhythmia. What should the nurse consider as being the cause for this abnormal heart rhythm? (Select all that apply) a.) Advanced age b.) Protein malnutrition c.) Fat deposits around the sinoatrial node d.) Fewer pacemaker cells in the sinoatrial node e.) Calcification around the atrioventricular node and valves
a.) Advanced age c.) Fat deposits around the sinoatrial node d.) Fewer pacemaker cells in the sinoatrial node e.) Calcification around the atrioventricular node and valves
A nurse in an emergency room is assessing a client who has a bradydysrhythmia. Which of the following findings should the nurse monitor for? a.) Confusion b.) Friction rub c.) Hypertension d.) Dry skin
a.) Confusion
A nurse is assessing a client who has dilated cardiomyopathy. Which of the following findings should the nurse expect? a.) Dyspnea on exertion b.) Tracheal deviation c.) Pericardial rub d.) Weight loss
a.) Dyspnea on exertion
A nurse is providing health teaching for a group of clients. Which of the following clients is at risk for developing peripheral arterial disease? a.) A client who has hypothyroidism b.) A client who has diabetes mellitus c.) A client whose daily caloric intake consists of 25% fat d.) A client who consumes two 12-oz bottles of beer a day
b.) A client who has diabetes mellitus
A patient becomes unresponsive without a palpable pulse despite showing bradycardia on the rhythm strip. What action should the nurse take immediately? (Select all that apply) a.) Auscultating heart sounds b.) Beginning cardiac compressions c.) Adjusting cardiac monitor leads d.) Obtaining blood samples for electrolytes e.) Placing epinephrine at the bedside
b.) Beginning cardiac compressions e.) Placing epinephrine at the bedside
A nurse is caring for a client who is 8 hr postoperative following a coronary artery bypass graft. Which of the following client findings should the nurse report? a.) Mediastinal drainage 100 mL/hr b.) Blood pressure of 160/80 c.) Temperature of 37.1 C d.) Potassium of 4.0 mEq/L
b.) Blood pressure of 160/80
A nurse is caring for a client who is being treated for heart failure and has a prescription for furosemide. The nurse should plan to monitor for which of the following as an adverse effect of this medication? a.) Shortness of breath b.) Lightheadedness c.) Dry cough d.) Metallic taste
b.) Lightheadedness
A nurse is caring for a client who was admitted for left-sided heart failure with intravenous loop diuretics and digitalis therapy. The client is experiencing weakness and an irregular heart rate. Which of the following actions should the nurse take first? a.) Obtain client's current weight b.) Review serum electrolyte values c.) Determine the time of the last digoxin dose d.) Check the client's urine output
b.) Review serum electrolyte values
A nurse is monitoring a client's ECG monitor and notes the clients rhythm has changed from normal sinus rhythm to supraventricular tachycardia. The nurse should prepare to assist with which of the following? a.) Delivery of a precordial thump b.) Vagal stimulation c.) Administration of atropine IV d.) Defibrillation
b.) Vagal stimulation
A patient is being cardioverted for symptomatic atrial fibrillation. At which point of the cardiac cycle will the electric impulse occur? a.) At the end of the P wave b.) Before the QRS complex c.) At the peak of the R wave d.) After the QRS complex but before the T wave
c.) At the peak of the R wave
A nurse is admitting a client who has a leg ulcer and a history of diabetes mellitus. The nurse should use which of the following focused assessments to help differentiate between an arterial ulcer and a venous stasis ulcer? a.) Explore the client's family history of peripheral vascular disease b.) Note the presence or absence of pain at the ulcer site c.) Inquire about the presence or absence of claudication d.) Ask if the client has had a recent infection
c.) Inquire about the presence or absence of claudication
A nurse is performing a cardiac assessment on a client. The nurse knows that the point of maximal impulse is found where? a.) Right 2nd intercostal space b.) Left 2nd intercostal space c.) Left 5th intercostal space
c.) Left 5th intercostal space
The nurse monitors for which clinical manifestation in the patient with atrial fibrillation at a heart rate of 90 beats per minute. Which manifestation should the nurse expect to assess in this patient? a.) Headache b.) Chest pain c.) Palpitations d.) Hypotension
c.) Palpitations
A nurse in an emergency department is caring for a client who had an anterior myocardial infarction. The client's history reveals she is 1 week postoperative following an open cholecystectomy. The nurse should recognize that which of the following interventions is contraindicated? a.) Administering IV morphine sulfate b.) Administering oxygen at 2 L/min via nasal cannula c.) Helping the client to the bedside commode d.) Assisting with thrombolytic therapy
d.) Assisting with thrombolytic therapy
A patient is being evaluated for a blockage in the cardiac ventricles. The nurse assesses which part of the ECG as evidence of this blockage? a.) T wave b.) U wave c.) PR interval d.) QRS interval
d.) QRS interval
Once ventricular fibrillation has been confirmed in a patient, which action is the priority? a.) Assessing vital signs b.) Opening the airway c.) Beginning rescue breathing d.) Starting chest compressions
d.) Starting chest compressions
A nurse is examining the ECG rhythm strip of her client on telemetry. Which area of the strip should the nurse observe for atrial depolarization? a.) P wave b.) QRS complex c.) T wave
a.) P wave
A nurse is planning a presentation for a group of clients who have hypertension. Which of the following lifestyle modifications should the nurse include? (Select all that apply) a.) Limited alcohol intake b.) Regular exercise program c.) Decreased magnesium intake d.) Reduced potassium intake e.) Tobacco cessation
a.) Limited alcohol intake b.) Regular exercise program e.) Tobacco cessation
The nurse notes that the patient with atrial fibrillation has hypotension and correlates this to decreased cardiac output secondary to which factor? a.) Loss of atrial kick b.) Decreased atrioventricular node conduction c.) Increased atrial contraction d.) Resistance to ventricular filling
a.) Loss of atrial kick
A nurse is caring for a client who has heart failure and is experiencing atrial fibrillation. The nurse should plan to monitor for and report which of the following findings to the provider immediately? a.) Slurred speech b.) Irregular pulse c.) Dependent edema d.) Persistent fatigue
a.) Slurred speech
The nurse is performing a cardiac assessment on a client. After palpating the client's skin, the nurse notices variations in skin temperature between different parts of the body. The nurse knows that this could be indicative of what? a.) Vascular disease b.) Hypothermia c.) Dehydration d.) Stroke
a.) Vascular disease
A nurse is providing discharge teaching for a client who has heart failure. The nurse should instruct the client to report which of the following findings immediately to the provider? a.) Weight gain of 2 lb in 24 hr b.) Increase of 10 mm Hg in systolic blood pressure c.) Dyspnea with exertion d.) Dizziness when rising quickly
a.) Weight gain of 2 lb in 24 hr
A nurse is caring for a postoperative client 1 hr following an aortic aneurysm repair. Which of the following findings can indicate shock and be reported to the provider? a.) Serosanguineous drainage on dressing b.) Severe pain with coughing c.) Urine output of 20 mL/hr d.) Increase in temperature from 36.8 C to 37.5 C
c.) Urine output of 20 mL/hr
A nurse is caring for a client who is receiving heparin therapy and develops hematuria. Which of the following actions should the nurse take if the client's aPTT is 96 seconds? a.) Increase the heparin infusion flow rate by 2 mL/hr b.) Continue to monitor the heparin infusion as prescribed c.) Request a prothrombin time (PT) d.) Stop the heparin infusion
d.) Stop the heparin infusion
When analyzing a patient's electrocardiogram, the nurse correlates which information as descriptive of a normal P wave? a.) Represents conduction through the AV node b.) Represents ventricular depolarization c.) The height of the P wave is 4 mm d.) The P length is 0.10 seconds
d.) The P length is 0.10 seconds
Warfarin, Heparin, Dabigatran, Rivaroxaban, Apixaban, Edoxaban
Class: Anticoagulant Action: Inhibits clot formation Rhythm: Atrial fibrillation, atrial flutter Monitor: Signs of bleeding, INR/PT/aPTT/platelets, renal function
The nurse provides care to a patient who is prescribed IV adenosine. Which is the priority nursing action before administering the medication? a.) Monitoring respirations b.) Palpating the patient's pulse c.) Teaching the patient to avoid caffeine intake d.) Ensuring a transcutaneous pacemaker is available
d.) Ensuring a transcutaneous pacemaker is available
In preparing a patient with atrial fibrillation for cardioversion, the nurse prepares the patient for which diagnostic test prior? a.) Chest x-ray b.) CT scan of the chest c.) 12-lead ECG d.) Transesophageal echocardiogram (TEE)
d.) Transesophageal echocardiogram (TEE)
A nurse is caring for a client who has endocarditis. Which of the following findings should the nurse recognize as a potential complication? a.) Ventricular depolarization b.) Guillain-Barre sydrome c.) Myelodysplastic syndrome d.) Valvular disease
d.) Valvular disease