MedSurg Exam 2 Practice Questions

Amiodarone

What is the drug of choice for a stable client with ventricular tachycardia?

Thromboembolism Thromboembolism is the most common complication of prosthetic valves and long-term anticoagulation with warfarin is initiated 48 hours after surgery.

Which of the following is the most common complication of prosthetic valves?

Pericardial effusion Cardiac tamponade Nurses caring for patients with pericarditis must be aware of the potential of serious complications. The two major complications of pericarditis are pericardial effusion, the accumulation of fluid in the pericardial sac, and cardiac tamponade, compression of the heart from excessive fluid build-up.

A 46-year-old man has been diagnosed with pericarditis and has begun treatment. When assessing this patient, the nurse should prioritize assessments relevant to what complications of pericarditis? Select all that apply.

"Spike" on the rhythm strip Confirmation that the client has a permanent pacemaker is the characteristic "spike" identified by a thin, straight stroke on the rhythm strip.

A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic?

"The enoxaparin will work immediately, but the warfarin takes several days to achieve its full effect." Oral anticoagulants such as warfarin are monitored by the prothrombin time (PT) or the international normalized ratio (INR). Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (i.e., when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0).

A client admitted to the medical-surgical unit with a venous thromboembolism (VTE) is started on enoxaparin and warfarin. The client asks the nurse why two medications are needed. Which response by the nurse is accurate?

Pericarditis

A client comes into the emergency department reporting about chest pain that gets worse when taking deep breaths and lying down. After ruling out a myocardial infarction, a nurse would assess for which diagnosis?

Morphine sulfate

A client develops cardiogenic pulmonary edema and is extremely apprehensive. What medication can the nurse administer with a health care provider's order that will relieve anxiety and slow respiratory rate?

atrial fibrillation In atrial fibrillation, several areas in the right atrium initiate impulses resulting in disorganized, rapid activity. The atria quiver rather than contract, producing a pulse deficit due to irregular impulse conduction to the AV node.

A client has an irregular heart rate of around 100 beats/minute and a significant pulse deficit. What component of the client's history would produce such symptoms?

30% The ejection fraction is normal in diastolic heart failure, but severely reduced in systolic heart failure. The normal EF is 55%-65%.

A client has been diagnosed with systolic heart failure. What percentage will the nurse expect the patient's ejection fraction to be?

Avoid sources of electrical interference. The nurse must instruct the client with a permanent pacemaker to avoid sources of electrical interference, such as MRI devices, large industrial motors, peripheral nerve stimulators, etc.

A client has had a pacemaker implanted and the nurse will begin client education upon the client becoming alert. Which postimplantation instructions must be provided to the client with a permanent pacemaker?

"During the procedure, the health care provider will insert a special wire used to increase the heart rate and produce the irregular beats that caused your signs and symptoms." The purpose of EPS is to study the heart's electrical system. During this invasive procedure, a special wire is introduced into the heart to produce dysrhythmia. To prepare for this procedure, the client should be NPO for 6 to 8 hours before the test, and all antiarrhythmics are held for at least 24 hours before the test in order to study the dysrhythmia without the influence of medications. Because the client's verbal responses to the rhythm changes are extremely important, sedation is avoided if possible.

A client is admitted to the hospital for evaluation of recurrent episodes of ventricular tachycardia as observed on Holter monitoring. The client is scheduled for electrophysiology studies (EPS) the following morning. Which statement should the nurse include in a teaching plan for this client?

Dyspnea, orthopnea, pulmonary edema

A client is admitted to the hospital with aortic stenosis. What assessment findings would indicate the development of left ventricular failure?

elevated erythrocyte sedimentation rate (ESR) elevated C-reactive protein elevated white blood cell (WBC) count

A client is diagnosed with infective endocarditis. What laboratory values will the nurse assess? Select all that apply.

Administer moderate sedation IV and analgesic medication as prescribed.

A client is scheduled for an elective electrical cardioversion for a sustained dysrhythmia lasting for 24 hours. Which intervention is necessary for the nurse to implement prior to the procedure?

Atrial flutter Atrial flutter is a disorder in which a single atrial impulse outside the SA node causes the atria to contract at an exceedingly rapid rate. The atrioventricular (AV) node conducts only some impulses to the ventricle, resulting in a ventricular rate slower than the atrial rate, thus forming a sawtooth pattern on the heart monitor.

A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder?

infective endocarditis Subacute endocarditis infections progress insidiously over weeks to months with vague manifestations, such as headache, malaise, fatigue, and sleep disturbances. Small, painless, red-blue macular lesions or Janeway lesions may appear on the palms of the hands and soles of the feet.

A client reports headaches and "just not feeling right," which the client blames on ongoing sleep disturbances. Inspection reveals Janeway lesions on the bottoms of the client's feet. These symptoms may indicate:

avoid caffeinated beverages If premature atrial complexes (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.

A client tells the nurse "my heart is skipping beats again; I'm having palpitations." After completing a physical assessment, the nurse concludes the client is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the client to

Leaning forward while sitting The nurse should encourage the client to lean forward, because this position causes the heart to pull away from the diaphragmatic pleurae of the lungs, thus helping to relieve chest pain caused by pericarditis.

A client who suffered blunt chest trauma in a motor vehicle accident reports chest pain during deep inspiration. On auscultation, the nurse detects a pericardial friction rub — a classic sign of acute pericarditis. To relieve this chest pain, which position should the nurse encourage the client to assume?

The aneurysm may be preparing to rupture.

A client with a diagnosed abdominal aortic aneurysm (AAA) develops severe lower back pain. Which is the most likely cause?

Shortness of breath Chronic mitral regurgitation is often asymptomatic, but acute mitral regurgitation (e.g., resulting from a myocardial infarction) usually manifests as severe congestive heart failure. Dyspnea, fatigue, and weakness are the most common symptoms.

A client with a myocardial infarction develops acute mitral valve regurgitation. The nurse knows to assess for which manifestation that would indicate that the client is developing pulmonary congestion?

Red or purple macules found on the palms of the hands Janeway lesions are painless, red or purple macules found on the palms and soles.

A client with infective endocarditis is assessed by the nurse for the presence of Janeway lesions. On inspection, the nurse recognizes these lesions by identifying which characteristic sign?

ventricular depolarization

A client with second-degree atrioventricular heart block is admitted to the coronary care unit. The nurse closely monitors the client's heart rate and rhythm. When interpreting the client's electrocardiogram (ECG) strip, the nurse knows that the QRS complex represents

failure of the ventricle to eject all blood during systole.

A fourth heart sound (S4) indicates a

Atropine The client is demonstrating signs and symptoms of symptomatic sinus bradycardia. Atropine is the medication of choice in treating symptomatic sinus bradycardia.

A nurse completes a shift assessment on a client admitted to the telemetry unit with a diagnosis of syncope. The client's heart rate is 55 bpm with a blood pressure of 90/66 mm Hg. The client is also experiencing dizziness and shortness of breath. Which medication will the nurse anticipate administering to the client based on these clinical findings?

"The client with mitral valve prolapse probably had no health symptoms." Most people with mitral valve prolapse (which occurs more often in women) never have symptoms. Frequently, the first and only sign is identified during a routine physical assessment, when the examiner hears an extra heart sound on auscultation. Mitral value prolapse is treated with beta blockers or valve repair.

A nurse is caring for a client newly diagnosed with mitral valve prolapse. The health care provider indicates the client has probably had this condition for years. What factor is important for the nurse to consider when teaching the client about valvular disease?

the high risk for complications if she becomes pregnant while taking warfarin 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.

A nurse is caring for a young female adult client diagnosed with atrial fibrillation who has just had a mitral valve replacement. The client is being discharged with prescribed warfarin. The client mentions to the nurse that she relies on the rhythm method for birth control. What education will be a priority for the nurse to provide to this client?

Rheumatic endocarditis Mitral stenosis is most often caused by rheumatic endocarditis, which progressively thickens the mitral valve leaflets and chordate tendineae. Leaflets often fuse together. Eventually, the mitral valve orifice narrows and progressively obstructs blood flow into the ventricle.

A nurse is conducting a health history on a client with a primary diagnosis of mitral stenosis. Which disorder reported by the client is the most common cause of mitral stenosis?

The valve has to be replaced frequently. Biological valves deteriorate and need to be replaced frequently.

A nurse is preparing a teaching plan regarding biological tissue valve replacement. What is a disadvantage of this type of valve replacement?

"I will need to take three different types of medications for the rest of my life to help prevent rejection." Clients who have had heart transplants are constantly balancing the risk of rejection with the risk of infection. They must adhere to a complex regimen of diet, medications, activity, follow-up laboratory studies, biopsies of the transplanted heart (to diagnose rejection), and clinic visits. Three classes of medications are prescribed for a transplant client to help minimize rejection: corticosteroids (e.g., prednisone), calcineurin inhibitors (tacrolimus, cyclosporin), and antiproliferative agents (mycophenolate mofetil, azathioprine, or sirolimus).

A nurse is teaching a client who is awaiting a heart transplant. Which statement indicates the client understands what is required to help minimize rejection?

Nitroglycerin A cholinergic blocking agent may cause dry mouth and delay the sublingual absorption of nitroglycerin. The nurse should offer the client sips of water before administering nitroglycerin.

A nurse reviews a client's medication history before administering a cholinergic blocking agent. Adverse effects of a cholinergic blocking agent may delay absorption of what medication?

A pulsatile abdominal mass Low back pain Lower abdominal pain

A nurse suspects the presence of an abdominal aortic aneurysm. What assessment data would the nurse correlate with a diagnosis of abdominal aortic aneurysm? (Select all that apply.)

Sinus tachycardia Sinus tachycardia occurs when the sinus node creates an impulse at a faster-than-normal rate. Causes include medications that stimulate the sympathetic response (e.g., catecholamines, aminophylline, atropine), stimulants (e.g., caffeine, nicotine), and illicit drugs (e.g., amphetamines, cocaine, Ecstasy).

A patient comes to the emergency department with reports of chest pain after using cocaine. The nurse assesses the patient and obtains vital signs with results as follows: blood pressure 140/92, heart rate 128, respiratory rate 26, and an oxygen saturation of 98%. What rhythm on the monitor does the nurse anticipate viewing?

Ventricular fibrillation The most common dysrhythmia in patients with cardiac arrest is ventricular fibrillation, which is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. No atrial activity is seen on the ECG. The most common cause of ventricular fibrillation is coronary artery disease and resulting acute myocardial infarction. Ventricular fibrillation is always characterized by the absence of an audible heartbeat, a palpable pulse, and respirations.

A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be?

Diazepam Prior to cardioversion, cardiac medications are held, and the client is sedated with a medication such as diazepam.

Which of the following medications does the nurse anticipate administering to a client preparing for cardioversion?

Nitroglycerin will dilate blood vessels, thus decreasing preload.

Function of Nitroglycerin in patient with angina?

Lidocaine is an antiarrhythmic that decreases myocardial irritability and decreases automaticity.

Purpose of IV Lidocaine in patient with acute myocardial infarction?

increased use of prosthetic valve replacements The prevalence of infective endocarditis among older adults has increased in part due to the increased number of prosthetic valve replacements, including replacements for older adults, and an increase in hospital-acquired bacteremia.

Statistics show an increase in the prevalence of infective endocarditis among older adults. Which factor places older adults at risk for developing infective endocarditis?

abdominal aorta, just below the renal arteries About 75% of aneurysms occur in the abdominal aorta, just below the renal arteries (Debakey type I aneurysms).

The most common site of aneurysm formation is in the

Document the findings and continue to monitor the patient The client's electrocardiogram (ECG) tracing indicates a first-degree atrioventricular (AV) block. First-degree AV block rarely causes any hemodynamic effect.

The nurse analyzes the electrocardiogram (ECG) strip of a stable patient admitted to the telemetry unit. The client's ECG strip demonstrates PR intervals that measure 0.24 seconds. What is the nurse's most appropriate action?

hypovolemia The causes of sinus tachycardia include physiologic or psychological stress (acute blood loss, anemia, shock, hypovolemia, fever, and exercise).

The nurse assesses a client with a heart rate of 120 beats per minute. What are the known causes of sinus tachycardia?

"I have to call my doctor so I can get antibiotics before seeing the dentist." Antibiotic prophylaxis is recommended for high-risk clients immediately before and sometimes after dental procedures.

The nurse determines that a client recently diagnosed with subacute bacterial endocarditis understands discharge teaching upon which client statement?

The sinoatrial (SA) node initiates the impulse. The characteristics of normal sinus rhythm are heart rate between 60 and 100 beats per minute; the SA node initiates the impulse; the impulse travels to the AV node in 0.12 to 0.2 seconds; the ventricles depolarize in 0.12 seconds or less; and each impulse occurs regularly.

The nurse documents that a client is having a normal sinus rhythm. What characteristics of this rhythm has the nurse assessed?

blood pressure Nitroglycerin can cause hypotension. A priority nursing assessment after the administration of nitroglycerin is the client's blood pressure.

The nurse has given a client a nitroglycerin tablet sublingually for angina. Which vital signs should be assessed following administration of nitroglycerin?

Hypokalemia PVCs can be caused by cardiac ischemia or infarction, increased workload on the heart (e.g., exercise, fever, hypervolemia, heart failure, tachycardia), digitalis toxicity, acidosis, or electrolyte imbalances, especially hypokalemia.

The nurse identifies which of the following as a potential cause of premature ventricular complexes (PVCs)?

Decreases the sinoatrial node automaticity Calcium channel blockers have a variety of effects on the ischemic myocardium. These agents decrease sinoatrial node automaticity and atrioventricular node conduction, resulting in a slower heart rate and a decrease in the strength of myocardial contraction (negative inotropic effect).

The nurse is administering a calcium channel blocker to a patient who has symptomatic sinus tachycardia at a rate of 132 bpm. What is the anticipated action of the drug for this patient?

The medication blocks sodium reabsorption in the ascending loop and dilate renal vessels.

The nurse is administering furosemide to a client with heart failure. What best describes the therapeutic action of the medication?

Delayed conduction, producing a prolonged PR interval. First-degree AV block may occur without an underlying pathophysiology, or it can result from medications or conditions that increase parasympathetic tone. It occurs when atrial conduction is delayed through the AV node, resulting in a prolonged PR interval.

The nurse is assessing a patient with a probable diagnosis of first-degree AV block. The nurse is aware that this dysrhythmia is evident on an ECG strip by what indication?

Extra heart sound Often the first and only sign of mitral valve prolapse is identified when a physical examination of the heart reveals an extra heart sound, referred to as a mitral click. Fatigue, dizziness, and syncope are other symptoms of mitral valve prolapse.

The nurse is auscultating the heart of a client diagnosed with mitral valve prolapse. Which is often the first and only manifestation of mitral valve prolapse?

dopamine Cardiogenic shock is when the heart has been significantly damaged and is unable to supply enough blood to the organs of the body. Dopamine, a sympathomimetic drug, improves myocardial contractility and blood flow through vital organs by increasing perfusion pressure.

The nurse is caring for a client in the intensive care unit. Which drug is most commonly used to treat cardiogenic shock?

Fluttering 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.

The nurse is caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client?

Lowering the limb so that it is dependent

The nurse is caring for a patient with peripheral arterial insufficiency. What can the nurse suggest to help relieve leg pain during rest?

Right side of sternum, fourth intercostal space view V1, the electrodes would be placed on the right side of the sternum, fourth intercostal space.

The nurse is placing electrodes for a 12-lead electrocardiogram (ECG). The nurse would be correct in placing an electrode on which area for V1?

During the procedure, the dysrhythmia will be reproduced under controlled conditions. During EP studies, the patient is awake and may experience symptoms related to the dysrhythmia. The client does not receive general anesthesia. The EP procedure time is not easy to determine. EP studies do not always include ablation of the dysrhythmia.

The nurse is preparing a client for upcoming electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia. What information will the nurse include in the teaching?

rheumatic fever The most significant risk factor for mitral stenosis is rheumatic fever, which gradually causes the mitral valve leaflets to thicken and can result in leaflet fusion.

The nurse is teaching a school community parent group about heart wellness. What risk factor is a common leading cause for mitral stenosis?

Administer an IV bolus of atropine. Atropine 0.5 mg given rapidly as an intravenous bolus every 3 to 5 minutes to a maximum total dose of 3.0 mg is the medication of choice in treating symptomatic second-degree heart block. The client may need to be sent to the cardiac catheterization lab for a temporary pacemaker, but atropine should be tried first.

The nurse is working on a telemetry unit, caring for a client who develops dizziness and a second-degree heart block, Mobitz Type 1. What will be the initial nursing intervention?

0.2 Each small block on the graph paper equals 0.04 second, and five small blocks form a large block, which equals 0.2 second.

The nurse is working on a telemetry unit. When the nurse is interpreting a client's heart rhythm, the nurse counts each large block on graph paper as how many seconds?

Atrial rate of 300 to 400 ECG characteristics of atrial fibrillation include an atrial rate of 300 to 400, a nonmeasurable PR interval, irregular rhythm, and no discernible P waves.

The nurse knows that electrocardiogram (ECG) characteristics of atrial fibrillation include what?

0.24 seconds In adults, the normal range for the PR is 0.12 to 0.20 seconds. A PR internal of 0.24 seconds would indicate a first-degree heart block.

The nurse knows that what PR interval presents a first-degree heart block?

fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) The classic signs and symptoms of pericarditis include fever, positional chest discomfort, nonspecific ST-segment elevation, elevated ESR, and pericardial friction rub.

The nurse suspects a client has developed pericarditis after a week of cold-like symptoms. Which of the client's signs and symptoms indicate pericarditis?

defibrillation Advanced cardiac life support recommends early defibrillation for witnessed ventricular fibrillation.

The nurse witnesses a client experiencing ventricular fibrillation. What is the nurse's priorityaction?

Cardiac glycosides

The nursing instructor is teaching the junior nursing students about aortic regurgitation. What classification of drugs are used to treat aortic regurgitation?

"Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast, with wide QRS complexes." Ventricular fibrillation is irregular with undulating waves and no QRS complex, while ventricular tachycardia is usually regular and fast with wide QRS complexes. The rhythms look different on the electrocardiogram strip. The QRS is wide and bizarre or undefined in ventricular fibrillation. The P-R interval is not present in the ventricular dysrhythmias.

The nursing student asks the nurse how to tell the difference between ventricular tachycardia and ventricular fibrillation on an electrocardiogram strip. What is the best response?

Atenolol Atenolol is a beta-blocker that can lower the heart rate.

The registered nurse reviewed the patient's vital signs and noted a consistent pattern of heart rate recordings between 48 and 58 bpm over a 24-hour period of time. What medication will cause bradycardia?

Third degree In third degree heart block, two impulses stimulate the heart, one impulse stimulates the ventricles and other stimulates the atria.

When no atrial impulse is conducted through the AV node into the ventricles, the client is said to be experiencing which type of AV block?

QRS complex

Which ECG waveform characterizes conduction of an electrical impulse through the left ventricle?

Low ejection fraction (EF)

Which feature is the hallmark of systolic heart failure?

Prolapse

Which mitral valve condition generally produces no symptoms?

Constant, intense back pain Decreasing blood pressure Decreasing hematocrit

Which of the following are indications of a rupturing aortic aneurysm? Select all that apply.

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.

Which signs and symptoms accompany a diagnosis of pericarditis?

Preload

Which term describes the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole?

Heterograft Heterograft, also called bioprosthesis, refers to replacement of tissue from animal tissue, usually pigs but also cows or horses.

Which type of graft is used when a heart valve replacement is made of tissue from an animal heart valve?

Cordarone

You are taking a pre-nursing pharmacology class. Today you are learning about anti-dysrhythmic drugs. What drug is a potassium channel blocker?

primary hypertension

denotes high blood pressure from an unidentified cause; also called essential hypertension