N241 Unit 3 Cardiac

You are providing discharge teaching to a patient being discharged home after hospitalization with pericarditis. The physician has ordered the patient to take Colchicine. Which of the following statements indicates the patient did NOT understand the education you provided? A. "I can take this medication with or without food." B. "I will notify the doctor immediately if I start experiencing nausea, vomiting, or stomach pain while taking this medication." C. "I like to take all my medications in the morning with grapefruit juice." D. "This medication is also used to treat patients with gout."

C. "I like to take all my medications in the morning with grapefruit juice." (Patients should not take Colchicine with grapefruit juice because it increases the amount of Colchicine the body absorbs (causing an increased chance of Colchicine toxicity). This medication can be taken WITH or WITHOUT food.)

You're providing discharge teaching to a patient being treated for endocarditis. Which statement by the patient demonstrated they understood your teaching about this condition? A. "I will stop taking the antibiotics once my fever is gone in order to prevent antibiotic resistance." B. "I will only wash my hands with soap and water." C. "I will inform my dentist about my history of endocarditis prior to any invasive procedures." D. "I will avoid eating fish and organ meats."

C. "I will inform my dentist about my history of endocarditis prior to any invasive procedures."

What teaching does the nurse include for a patient with atrial fibrillation who has a new prescription for warfarin? A. "It is important to consume a diet high in green leafy vegetables." B. "You would take aspirin or ibuprofen for headache." C. "Report nosebleeds to your provider immediately." D. "Avoid caffeinated beverages."

C. "Report nosebleeds to your provider immediately."

A client undergoing coronary artery bypass grafting asks why the surgeon has chosen to use the internal mammary artery for the surgery. Which response by the nurse is correct? A. "This way you will not need to have a leg incision." B. "The surgeon prefers this approach because it is easier." C. "These arteries remain open longer." D. "The surgeon has chosen this approach because of your age."

C. "These arteries remain open longer."

As the nurse you know that in order for hypovolemic shock to occur the patient would need to lose __________ of their blood volume. A. <30% B. >25% C. >15% D. >10%

C. >15%

Which waveform indicates proper function of the sinoatrial (SA) node? A. The QRS complex is present. B. The PR interval is 0.24 second. C. A P wave precedes every QRS complex. D. The ST segment is elevated.

C. A P wave precedes every QRS complex.

A patient who is experiencing hypovolemic shock has decreased cardiac output, which contributes to ineffective tissue perfusion. The decrease in cardiac output occurs due to? A. An increase in cardiac preload B. An increase in stroke volume C. A decrease in cardiac preload D. A decrease in cardiac contractility

C. A decrease in cardiac preload

The nurse is evaluating the condition of a client after pericardiocentesis performed to treat cardiac tamponade. Which observation would indicate that the procedure was effective? A. Muffled heart sounds B. Client reports SOB C. A rise in blood pressure D. JVD

C. A rise in blood pressure

A patient with atrial fibrillation (AF) with rapid ventricular response has received medication to slow the ventricular rate. The pulse is now 88 beats/min. For which additional therapy does the nurse plan? A. Synchronized cardioversion B. Electrophysiology studies (EPS) C. Anticoagulation D. Radiofrequency ablation therapy

C. Anticoagulation

An older adult client, 4 hours after coronary artery bypass graft (CABG), has a blood pressure of 80/50 mm Hg. What action does the nurse take? A. No action is required; low blood pressure is normal for older adults. B. No action is required for postsurgical CABG clients. C. Assess pulmonary artery wedge pressure (PAWP). D. Give ordered loop diuretics.

C. Assess pulmonary artery wedge pressure (PAWP).

Which diagnostic test result is consistent with a diagnosis of heart failure (HF)? A. Serum potassium level of 3.2 mEq/L (3.2 mmol/L) B. Ejection fraction of 60% C. B-type natriuretic peptide (BNP) of 760 pg/mL (760 ng/dL) D. Chest x-ray report showing right middle lobe consolidation

C. B-type natriuretic peptide (BNP) of 760 pg/mL (760 ng/dL)

A patient is hospitalized with chronic pericarditis. On assessment, you note the patient has pitting edema in lower extremities, crackles in lungs, and dyspnea on excretion. The patient's echocardiogram shows thickening of the pericardium. This is known as what type of pericarditis? A. Pericardial effusion B. Acute pericarditis C. Constrictive pericarditis D. Effusion-Constrictive pericarditis

C. Constrictive pericarditis (The key words in this question are: the patient's signs and symptoms which indicate heart failure (a common finding with patients who have constrictive pericarditis) and that the echo showed "thickening" of the pericardium.)

A client with heart failure reports a 7.6-pound (3.4 kg) weight gain in the past week. What intervention does the nurse anticipate from the primary health care provider? A. Dietary consult B. Sodium restriction C. Daily weight monitoring D. Restricted activity

C. Daily weight monitoring

The nurse is teaching a group of teens about prevention of heart disease. Which point is most important for the nurse to emphasize? A. Reduce abdominal fat. B. Avoid stress. C. Do not smoke or chew tobacco. D. Avoid alcoholic beverages.

C. Do not smoke or chew tobacco.

A 35-year-old male arrives to the emergency room with multiple long bone fractures and an internal abdominal injury. The patient is anxious. Patient's vital signs are: Blood pressure 70/54, heart rate 125 bpm, respirations 30, oxygen saturation on 2 L nasal cannula 96%, temperature 99.3 'F, pain 6 on 1-10 scale. During assessment it is noted the skin is cool and clammy. The nurse will make it priority to? A. Collect a urine sample B. Obtain an EKG C. Establish 2 large-bore IV access sites D. Place a warming blanket on the patient

C. Establish 2 large-bore IV access sites

The patient with hypovolemic shock is in need of clotting factors. Which type of fluid would best benefit this patient? A. Platelets B. Albumin C. Fresh Frozen Plasma D. Packed Red Blood Cells

C. Fresh Frozen Plasma

The nurse in the emergency department is caring for a client with acute heart failure who is experiencing severe dyspnea, with pink, frothy sputum, and crackles throughout the lung fields. The nurse reviews the medical record, which contains the following information: Physical Assessment Findings Diagnostic Findings Provider Prescriptions Crackles in all fieldsS3 presentOliguriaEjection fraction 30%BNP 560Sodium 130 mEq/L (130 mmol/L)Diagnosis: heart failureEnalapril 10 mg orally dailyHeparin 5000 units subcutaneously every 12 hoursFurosemide 40 mg IV dailyStrict I & O A. Enalapril B. Heparin C. Furosemide D. Intake and output (I & O)

C. Furosemide (While caring for a client with acute heart failure, the ED nurse Administers Furosemide first. The client is displaying typical signs of acute pulmonary edema secondary to fluid-filled alveoli and pulmonary congestion. A diuretic will promote fluid loss.)

One of your patients begins to vomit large amounts of bright red blood. The patient is taking Warfarin. You call a rapid response. Which assessment findings indicate this patient is developing hypovolemic shock? Select all that apply: A. Temperature 104.8 'F B. Heart rate 40 bpm C. Heart rate 140 bpm D. Anxiety, restlessness E. Urinary output 15 mL/hr F. Blood pressure 70/56 G. Pale, cool skin H. Weak peripheral pulses I. Blood pressure 220/106

C. Heart rate 140 bpm D. Anxiety, restlessness E. Urinary output 15 mL/hr F. Blood pressure 70/56 G. Pale, cool skin H. Weak peripheral pulses

A client is diagnosed with a STEMI and is receiving a tissue plasminogen activator, Alteplase. Which action is a priority nursing intervention? A. Monitor for kidney failure B. Monitor psychosocial status C. Monitor for signs of bleeding D. Have heparin sodium available

C. Monitor for signs of bleeding

The visiting nurse is seeing a client postoperative for coronary artery bypass graft. Which nursing action would be performed first? A. Assess coping skills. B. Assess for postoperative pain at the client's incision site. C. Monitor the heart rate for dysrhythmias. D. Monitor mental status.

C. Monitor the heart rate for dysrhythmias.

Which treatments below would decrease cardiac preload? Select all that apply: A. IV fluid bolus B. Norepinephrine C. Nitroglycerin D. Furosemide

C. Nitroglycerin D. Furosemide (Nitroglycerin is a vasodilator that will dilate vessels, which will decrease venous return to the heart and this will decrease preload. Furosemide is a diuretic which will remove extra fluid from the body via the kidneys. This will decrease venous return to the heart and decrease preload)

A patient is receiving treatment for infective endocarditis. The patient has a history of intravenous drug use and underwent mitral valve replacement a year ago. The patient is scheduled for a transesophageal echocardiogram tomorrow. On assessment, you find tender, red lesions on the patient's hands and feet. You know that this is a common finding in patients with infective endocarditis and is known as? A. Janeway Lesions B. Roth Spots C. Osler's Nodes D. Trousseau's Sign

C. Osler's Nodes (.Osler's Nodes. They are TENDER, red lesions on the hands and feet. Don't get this confused with Janeway Lesions which are NON-TENDER, red lesions on the PALMS of the hands and SOLES of the feet. Roth spots are retinal hemorrhages with white centers and Trousseau's Sign is found in hypocalcemia.)

A client recovering from cardiac angiography develops slurred speech. What does the nurse do first? A. Maintains NPO (nothing by mouth) until this resolves B. Calls in another nurse for a second opinion C. Performs a complete neurologic assessment and notifies the primary care provider D. Explains to the client and family that this is expected after sedation

C. Performs a complete neurologic assessment and notifies the primary care provider

A client who has a new diagnosis of hypertension has a prescription for an ACE inhibitor. The nurse instructs the client about the adverse effects of the medication. The client demonstrates an understanding of the teaching by stating that he will notify his provider if he experiences which of the following? A. Tendon Pain B. Constipation C. Persistent cough D. Frequent urination

C. Persistent cough

Which intervention best assists the client with acute pulmonary edema in reducing anxiety and dyspnea? A. Monitor pulse oximetry and cardiac rate and rhythm. B. Reassure the client that his distress can be relieved with proper intervention. C. Place the client in high-Fowler's position with the legs down. D. Ask a family member to remain with the client.

C. Place the client in high-Fowler's position with the legs down.

You are providing care to a patient with pericarditis. Which of the following is NOT a proper nursing intervention for this patient? A. Monitor the patient for complications of cardiac tamponade. B. Administer Ibuprofen as scheduled. C. Place the patient in supine position to relieve pain. D. Monitor the patient for pulsus paradoxus and muffled heart sounds.

C. Place the patient in supine position to relieve pain. (The high Fowler's position or leaning forward is the best position for a patient with pericarditis.)

The nurse is caring for a client in phase 1 cardiac rehabilitation. Which activity does the nurse suggest? A. The need to increase activities slowly at home B. Planning and participating in a walking program C. Placing a chair in the shower for independent hygiene D. Consultation with social worker for disability planning

C. Placing a chair in the shower for independent hygiene

Which problem places a client at highest risk for sepsis? A. Pernicious anemia B. Pericarditis C. Post kidney transplant D. Client owns an iguana

C. Post kidney transplant

A patient with endocarditis has listed in their medical history "Roth Spots". You know that this is a complication of infective endocarditis and presents as? A. Non-tender spots found on the feet and hands B. Red and tender lesions found in the eyes C. Retinal hemorrhages with white centers D. Purplish spots found on the forearms and groin

C. Retinal hemorrhages with white centers

A 72-year-old client admitted with fatigue and dyspnea has elevated levels of all of these laboratory results. Which finding is consistent with acute coronary syndrome (ACS) and must be communicated immediately to the primary health care provider? A. White blood cell count B. Low-density lipoproteins C. Serum troponin I level D. C-reactive protein

C. Serum troponin I level

Which intervention provides safety during cardioversion? A. Setting the defibrillator at 220 joules B. Obtaining informed consent C. Setting the defibrillator to the synchronized mode D. Removing oxygen

C. Setting the defibrillator to the synchronized mode

A patient's rhythm strip shows a heart rate of 116 beats/min, one P wave occurring before each QRS complex, a PR interval measuring 0.16 second, and a QRS complex measuring 0.08 second. How does the nurse interpret this rhythm strip? A. Normal sinus rhythm B. Sinus bradycardia C. Sinus tachycardia D. Sinus rhythm with premature ventricular contractions

C. Sinus tachycardia

The nurse is assessing a client with a cardiac infection. Which symptoms support the diagnosis of infective endocarditis instead of pericarditis or rheumatic carditis? A. Friction rub auscultated at the left lower sternal border B. Pain aggravated by breathing, coughing, and swallowing C. Splinter hemorrhages D. Thickening of the endocardium

C. Splinter hemorrhages

What typical sign/symptom indicates the early stage of septic shock? A. Pallor and cool skin B. Blood pressure 84/50 mm Hg C. Tachypnea and tachycardia D. Respiratory acidosis

C. Tachypnea and tachycardia

Which nursing intervention for a client admitted today with heart failure will assist the client to conserve energy? A. The client ambulates around the nursing unit with a walker. B. The nurse monitors the client's pulse and blood pressure frequently. C. The nurse obtains a bedside commode before administering furosemide. D. The nurse returns the client to bed when the client becomes tachycardic.

C. The nurse obtains a bedside commode before administering furosemide.

The professional nurse is supervising a nursing student performing a 12-lead electrocardiogram (ECG). Under which circumstance does the nurse correct the student? A. The patient is semi-recumbent in bed. B. Chest leads are placed as for the previous ECG. C. The patient is instructed to breathe deeply through the mouth. D. The patient is instructed to lie still.

C. The patient is instructed to breathe deeply through the mouth.

Which statement best reflects correct client education for a client with a blood pressure (BP) of 136/86 mm Hg? A. This blood pressure is good because it is a normal reading. B. This blood pressure indicates that the client has hypertension or high blood pressure. C. This blood pressure increases the workload of the heart; the client must consider modifying his or her lifestyle. D. This blood pressure seems a little low; the client must be further assessed for orthostatic hypotension.

C. This blood pressure increases the workload of the heart; the client must consider modifying his or her lifestyle.

A patient is admitted with sepsis. The patient has a temperature of 104.2 'F and is experiencing chills. On assessment, you note a mitral murmur which the patient states they've never had before, and dark, small lines on the patient's fingernails. The patient has a history of IV drug use in the past. However, the patient states they are no longer using drugs. The physician suspects possible infective endocarditis. What diagnostic test do you expect the physician to order in order to confirm the presence of infective endocarditis? A. Abdominal ultrasound B. Heart catheterization C. Transesophageal echocardiogram D. White blood cell count

C. Transesophageal echocardiogram (TEE is an ultrasound performed to look at the back side of the heart and assesses the valve structure. It is a test used to diagnose vegetations found on the valves)

The nurse notes that a client with sinus rhythm has a PVC that falls on the T wave of the preceding beat. The client's rhythm suddenly changes to one with no P waves, no definable QRS complexes, and coarse wavy lines of varying amplitude. How should the nurse interpret this rhythm? A. Asystole B. Atrial Fibrillation C. Ventricular fibrillation D. ventricular tachycardia

C. Ventricular fibrillation

When following up in the clinic with a client with heart failure, how does the nurse recognize that the client has been compliant with fluid restrictions? A. Auscultation of crackles B. Pedal edema C. Weight loss of 6 pounds (2.7 kg) since the last visit D. Reports sucking on ice chips all day for dry mouth

C. Weight loss of 6 pounds (2.7 kg) since the last visit

You are providing care to a patient experiencing chest pain when coughing or breathing in. The patient has pericarditis. The physician has ordered the patient to take Ibuprofen for treatment. How will you administer this medication? A. strictly without food B. with a full glass of juice C. with a full glass of water D. with or without food

C. with a full glass of water

Treatment for Atrial Fibrillation

CCB (Cardizem) and anticoagulant therapy

What is Cardiogenic Shock?

Class IV Heart Failure Acute MI is most common cause of direct pump failure. EARLY Detection is very important

Each small box is _____ seconds?

0.04

Normal QRS interval time?

0.06-0.12 seconds

Normal PR interval time?

0.12-0.20 seconds

Normal QT interval time?

0.36-0.44 seconds

A client has frequent bursts of ventricular tachycardia on the cardiac monitor. What should the nurse be most concerned about with this dysrhythmia? 1. It can develop into ventricular fibrillation at any time. 2. It is almost impossible to convert to a normal rhythm. 3. It is uncomfortable for the client, giving a sense of impending doom. 4. It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia.

1. It can develop into ventricular fibrillation at any time

Normal range for CVP?

2-8 mmHg

The nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. No P waves or QRS complexes are seen; instead, the monitor screen shows an irregular wavy line. The nurse interprets that the client is experiencing which rhythm? 1.Sinus tachycardia 2.Ventricular fibrillation 3.Ventricular tachycardia 4.Premature ventricular contractions (PVCs)

3.Ventricular tachycardia

Normal Cardiac Output?

4-7 L/min

A client is having frequent premature ventricular contractions. The nurse should place priority on assessment of which item? 1.Sensation of palpitations 2.Causative factors, such as caffeine 3.Precipitating factors, such as infection 4.Blood pressure and oxygen saturation

4.Blood pressure and oxygen saturation

One second is __ large boxes

5 large boxes

Each large box is ___ small squares or _____ seconds

5 small squares or 0.20 seconds

Normal Ejection Fraction?

50-70%

Normal MAP?

60-70= good perfusion <60= decreased perfusion

What is Marfan's syndrome?

A genetic/hereditary condition affecting connective tissue of the body.

What is an Angioplasty?

A stent used to bridge the patient to CABG, if needed

What is Impella?

A ventricular assistive device to help the heart until lit can be repaired or give it an opportunity to heal

The nurse is providing discharge teaching to a client with heart failure, focusing on when to seek medical attention. Which statement by the client indicates a correct understanding of the teaching? A. "I will call the provider if I have a cough lasting 3 or more days." B. "I will report to the provider weight loss of 2 to 3 pounds (0.9 to 1.4 kg) in a day." C. "I will try walking for 1 hour each day." D. "I should expect occasional chest pain."

A. "I will call the provider if I have a cough lasting 3 or more days."

A client with unstable angina has received education about acute coronary syndrome. Which statement indicates that the client has understood the teaching? A. "This is a big warning; I must modify my lifestyle or I am at risk for having a heart attack." B. "Angina is just a temporary interruption of blood flow to my heart." C. "I need to tell my wife I've had a heart attack." D. "Because this was temporary, I will not need to take any medications for my heart."

A. "This is a big warning; I must modify my lifestyle or I am at risk for having a heart attack."

Which of the following patients are MOST at risk for developing endocarditis? Select-all-that-apply: A. A 25 year old male who reports using intravenous drugs on a daily basis. B. A 55 year old male who is post-opt from aortic valve replacement. C. A 63 year old female who is newly diagnosed with hyperparathyroidism and is taking Aspirin. D. A 66 year old female who recently had an invasive dental procedure performed 1 month ago and is having a fever.

A. A 25 year old male who reports using intravenous drugs on a daily basis. B. A 55 year old male who is post-opt from aortic valve replacement. D. A 66 year old female who recently had an invasive dental procedure performed 1 month ago and is having a fever.

You're providing care to four patients. Select all the patients who are at risk for developing sepsis: A. A 35-year-old female who is hospitalized with renal insufficiency and has a Foley catheter and central line in place. B. A 55-year-old male who is a recent kidney transplant recipient. C. A 78-year-old female with diabetes mellitus who is recovering from colon surgery. D. A 65-year-old male recovering from right lobectomy for treatment of lung cancer.

A. A 35-year-old female who is hospitalized with renal insufficiency and has a Foley catheter and central line in place. B. A 55-year-old male who is a recent kidney transplant recipient. C. A 78-year-old female with diabetes mellitus who is recovering from colon surgery. D. A 65-year-old male recovering from right lobectomy for treatment of lung cancer.

After receiving change-of-shift report about these four clients, which client would the nurse assess first? A. A 46-year-old with aortic stenosis who takes digoxin (Lanoxin) and has new-onset frequent premature ventricular contractions (PVCs) B. A 55-year-old admitted with pulmonary edema who received furosemide (Lasix) and whose current O2 saturation is 94% C. A 68-year-old with pericarditis who is reporting sharp, stabbing chest pain when taking deep breaths D. A 79-year-old admitted for possible rejection of a heart transplant who has sinus tachycardia, heart rate 104 beats/min

A. A 46-year-old with aortic stenosis who takes digoxin (Lanoxin) and has new-onset frequent premature ventricular contractions (PVCs) (The nurse would first assess the 46-year-old with aortic stenosis on digoxin and now has new-onset frequent PVCs. The PVCs may be indicative of digoxin toxicity. Further assessment for clinical manifestations of digoxin toxicity must be done and the primary health care provider notified about the dysrhythmia.)

The nurse is watching the cardiac monitor, and a client's rhythm suddenly changes. There are no P waves; instead, there are fibrillatory waves before each QRS complex. How should the nurse interpret the client's heart rhythm? A. A Fib B. Sinus Tachy C. V Fib D. V tach

A. A Fib

A 30 year old female is being treated for infective endocarditis with IV antibiotics. At the beginning of the hospitalization, the patient's symptoms were severe and sudden with a high fever but are now controlled. She has no significant health history other than 2 cesarean sections in the past. She is being prepped for a central line placement so she can be discharged home with home health to continue the 4 week antibiotic regime. What is type of infective endocarditis this classified as based on the information listed? A. Acute Infective Endocarditis B. Subacute Infective Endocarditis C. Non-infective Endocarditis D. Pericarditis

A. Acute Infective Endocarditis

The nurse in a medical unit is caring for a client with HF. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles. The nurse immediately asks another nurse to contact the HCP and prepares to implement with priority interventions? SATA A. Administering O2 B. Inserting a foley catheter C. Administering furosemide D. Administering morphine sulfate IV E. Transporting the client to the coronary care unit. F. Placing the client in a low-Fowler's side-lying position

A. Administering O2 B. Inserting a foley catheter C. Administering furosemide D. Administering morphine sulfate IV

A client is exhibiting signs and symptoms of early shock. What is important for the nurse to do to support the psychosocial integrity of the client? Select all that apply. A. Ask family members to stay with the client. B. Call the health care provider. C. Increase IV and oxygen rates. D. Remain with the client. E. Reassure the client that everything is being done for him or her.

A. Ask family members to stay with the client. D. Remain with the client. E. Reassure the client that everything is being done for him or her.

Which statement reflects correct cardiac physical assessment technique? A. Auscultate the aortic valve in the second intercostal space at the right sternal border. B. Evaluate for orthostatic hypotension by moving the client from a standing to a reclining position. C. Palpate the apical pulse over the third intercostal space in the midclavicular line. D. Assess for carotid bruit by auscultating over the anterior neck.

A. Auscultate the aortic valve in the second intercostal space at the right sternal border.

A nurse is reviewing cardiac biomarker lab values on a client experiencing angina. Which lab test is not considered a cardiac biomarker? A. BNP B. Myoglobin C. Troponin T and I D. Creatine Kinase (CK)/Ck-MB

A. BNP

The nurse is caring for a patient who has developed a bradycardia. Which possible causes does the nurse investigate? Select all that apply. A. Bearing down for a bowel movement B. Possible inferior wall myocardial infarction (MI) C. Patient stating that he just had a cup of coffee D. Patient becoming emotional when visitors arrived E. Diltiazem (Cardizem) administered 1 hour ago

A. Bearing down for a bowel movement B. Possible inferior wall myocardial infarction (MI) E. Diltiazem (Cardizem) administered 1 hour ago

Your patient, who is post-op from a gastrointestinal surgery, is presenting with a temperature of 103.6 'F, heart rate 120, blood pressure 72/42, increased white blood cell count, and respirations of 21. An IV fluid bolus is ordered STAT. Which findings below indicate that the patient is progressing to septic shock? Select all that apply: A. Blood pressure of 70/34 after the fluid bolus B. Serum lactate less than 2 mmol/L C. Patient needs Norepinephrine to maintain a mean arterial pressure (MAP) greater than 65 mmHg despite fluid replacement D. Central venous pressure (CVP) of 18

A. Blood pressure of 70/34 after the fluid bolus C. Patient needs Norepinephrine to maintain a mean arterial pressure (MAP) greater than 65 mmHg despite fluid replacement

The nurse caring for a client with heart failure is concerned that digoxin toxicity has developed. For which signs and symptoms of digoxin toxicity does the nurse notify the provider? Select all that apply. A. Blurred vision B. Tachycardia C. Fatigue D. Serum digoxin level of 1.5 ng/ml (1.92 nmol/L) E. Anorexia

A. Blurred vision C. Fatigue E. Anorexia

A client is admitted to the hospital with two of the systemic inflammatory response syndrome variables: temperature of 95°F (35°C) and high white blood cell count. Which intervention from the sepsis resuscitation bundle does the nurse initiate? A. Broad-spectrum antibiotics B. Blood transfusion C. Cooling baths D. NPO status

A. Broad-spectrum antibiotics

The nurse is caring for a client with heart failure. For which symptoms does the nurse assess? Select all that apply. A. Chest discomfort or pain B. Tachycardia C. Expectorating thick, yellow sputum D. Sleeping on back without a pillow E. Fatigue

A. Chest discomfort or pain B. Tachycardia E. Fatigue

The nurse is caring for a patient with advanced heart failure who develops asystole. The nurse corrects the graduate nurse when the graduate offers to perform which intervention? A. Defibrillation B. Cardiopulmonary resuscitation (CPR) C. Administration of epinephrine D. Administration of oxygen

A. Defibrillation (Defibrillation interrupts the heart rhythm and allows normal pacemaker cells to take over. In asystole, there is no rhythm to interrupt.)

The client with which problem is at highest risk for hypovolemic shock? A. Esophageal varices B. Kidney failure C. Arthritis and daily acetaminophen use D. Kidney stone

A. Esophageal varices (The client with esophageal varices is at highest risk for hypovolemic shock. Esophageal varices are caused by portal hypertension where the portal vessels are under high pressure. With this high pressure, the portal vessels are prone to rupture, causing massive upper gastrointestinal tract bleeding and hypovolemic shock.)

A client who is suffering from dyspnea on exertion and congestive heart failure (CHF) will most likely report which symptom during the health history? A. Fatigue B. Swelling of one leg C. Slow heart rate D. Brown discoloration of lower extremities

A. Fatigue

What two factors are used to calculate cardiac output? Select all that apply: A. Heart rate B. Blood pressure C. Stroke volume D. Mean arterial pressure

A. Heart rate C. Stroke volume

The nurse is caring for a patient with atrial fibrillation (AF). In addition to an antidysrhythmic, what medication does the nurse plan to administer? A. Heparin B. Atropine C. Dobutamine D. Magnesium sulfate

A. Heparin

What are the typical signs and symptoms of infective endocarditis? SATA A. Hyperthermia B. S4 gallop C. Enlarged Spleen D. Hyperkalemia E. Substernal pain that radiates to the back F. Heart failure G. Cardiac Murmur

A. Hyperthermia C. Enlarged Spleen F. Heart failure G. Cardiac Murmur

he nurse is caring for an 82-year-old client admitted for exacerbation of heart failure (HF). The nurse questions the client about the use of which medication because it raises an index of suspicion as to the worsening of the client's HF? A. Ibuprofen (Motrin) B. Hydrochlorothiazide (HydroDIURIL) C. NPH insulin D. Levothyroxine (Synthroid)

A. Ibuprofen (Motrin) (Long-term use of nonsteroidal antiinflammatory drugs such as ibuprofen (Motrin) causes fluid and sodium retention, which can worsen a client's HF.)

The client with which laboratory result is at risk for hemorrhagic shock? A. International normalized ratio (INR) 7.9 B. Partial thromboplastin time (PTT) 12.5 seconds C. Platelets 170,000/mm3 (170 × 109/L) D. Hemoglobin 8.2 g/dL (82 mmol/L)

A. International normalized ratio (INR) 7.9

You're providing care to a patient who has experienced a 45% loss of their fluid volume and is experiencing hypovolemic shock. The patient has hemodynamic monitoring and fluid resuscitation is being attempted. Which finding indicates the patient is still in hypovolemic shock? A. Low central venous pressure B. High pulmonary artery wedge pressure C. Elevated mean arterial pressure D. Low systemic vascular resistance

A. Low central venous pressure

Your patient is receiving aggressive treatment for septic shock. Which findings demonstrate treatment is NOT being successful? Select all that apply: A. MAP (mean arterial pressure) 40 mmHg B. Urinary output of 10 mL over 2 hours C. Serum Lactate 15 mmol/L D. Blood glucose 120 mg/dL E. CVP (central venous pressure) less than 2 mmHg

A. MAP (mean arterial pressure) 40 mmHg B. Urinary output of 10 mL over 2 hours C. Serum Lactate 15 mmol/L E. CVP (central venous pressure) less than 2 mmHg

Which client has the highest risk for cardiovascular disease? A. Man who smokes and whose father died at 49 of myocardial infarction (MI) B. Woman with abdominal obesity who exercises three times per week C. Woman with diabetes whose high-density lipoprotein (HDL) cholesterol is 75 mg/dL (1.94 mmol/L) D. Man who is sedentary and reports four episodes of strep throat

A. Man who smokes and whose father died at 49 of myocardial infarction (MI)

A patient is 1 hour post-op from abdominal surgery and had lost 20% of their blood volume during surgery. The patient is experiencing signs and symptoms of hypovolemic shock. What position is best for this patient? A. Modified Trendelenburg B. Trendelenburg C. High Fowler's D. Supine

A. Modified Trendelenburg (Modified Trendelenburg position is where the patient is supine with their legs elevated at 45 degrees. This will help increase venous return to the heart (hence increase preload), which will help increase cardiac output.)

When planning care for a client in the emergency department, which interventions are needed in the acute phase of myocardial infarction (MI)? Select all that apply. A. Oxygen B. Morphine sulfate C. Nitroglycerin D. Naloxone E. Acetaminophen F. Verapamil (Calan, Isoptin)

A. Oxygen B. Morphine sulfate

The nurse is caring for a patient with heart rate of 143 beats/min. For which manifestations does the nurse observe? Select all that apply. A. Palpitations B. Increased energy C. Chest discomfort D. Flushing of the skin E. Hypotension

A. Palpitations C. Chest discomfort E. Hypotension

A patient admitted after using crack cocaine develops ventricular fibrillation. After determining unresponsiveness, which action does the nurse take next? A. Prepare for defibrillation. B. Establish IV access. C. Place an oral airway and ventilate. D. Start cardiopulmonary resuscitation (CPR).

A. Prepare for defibrillation. (Defibrillating is the priority next action before any other resuscitative measures, according to advanced cardiac life support protocols.After immediate defibrillation, establish IV access, place an oral airway, and ventilate. CPR will be started after unsuccessful defibrillation.)

The nurse is caring for a client with heart failure. Which of the following are characteristics of systolic heart failure?SELECT ALL THAT APPLY A. Reduced ejection fraction B. Normal ejection fraction C. Stiff heart muscle D. Change in contraction of ventricles E. Weak heart muscle

A. Reduced ejection fraction D. Change in contraction of ventricles E. Weak heart muscle

A patient with an MI of the Inferior wall of the right ventricle most likely has a blockage of the: A. Right coronary artery B. Left anterior descending artery C. Left circumflex artery D. Right anterior descending artery

A. Right coronary artery

The nurse is monitoring a client for adverse effects of medications. Which findings are characteristic of adverse effects of hydrochlorothiazide? SATA A. Sulfa allergy B. Osteoporosis C. Hypokalemia D. Hypouricemia E. Hyperglycemia F. Hypercalcemia

A. Sulfa allergy C. Hypokalemia E. Hyperglycemia F. Hypercalcemia

A client has developed atrial fibrillation, which a ventricular rate of 150 beats per minute. A nurse assesses the client for which associated signs and/or symptoms? SATA A. Syncope B. Dizziness C. Palpitations D. Hypertension E. Flat neck veins

A. Syncope B. Dizziness C. Palpitations

A client recovering from an open reduction of the femur suddenly feels light-headed, with increased anxiety and agitation. Which key vital sign differentiates a pulmonary embolism from early sepsis? A. Temperature B. Pulse C. Respiration D. Blood pressure

A. Temperature

After receiving change-of-shift report in the coronary care unit, which client does the nurse assess first? A. The client with acute coronary syndrome who has a 3-pound (1.4 kg) weight gain and dyspnea B. The client with percutaneous coronary angioplasty who has a dose of heparin scheduled C. The client who had bradycardia after a myocardial infarction and now has a paced heart rate of 64 beats/min D. A client who has first-degree heart block, rate 68 beats/min, after having an inferior myocardial infarction

A. The client with acute coronary syndrome who has a 3-pound (1.4 kg) weight gain and dyspnea

The physician orders a patient in septic shock to receive a large IV fluid bolus. How would the nurse know if this treatment was successful for this patient? A. The patient's blood pressure changes from 75/48 to 110/82. B. Patient's CVP 2 mmHg C. Patient's skin is warm and flushed. D. Patient's urinary output is 20 mL/hr.

A. The patient's blood pressure changes from 75/48 to 110/82.

Which statement is true about colloid solutions? Select all that apply: A. These solutions are made up of large molecules that cannot diffuse through the capillary wall, so more fluid stays in the intravascular space longer when compared with the action of a crystalloid solution. B. These solutions can diffuse through the capillary wall so less fluid stays in the intravascular system when compared to the action of a crystalloid solution. C. The nurse should monitor for an anaphylactic reaction when these products are administered. D. These fluids are considered hypertonic solutions.

A. These solutions are made up of large molecules that cannot diffuse through the capillary wall, so more fluid stays in the intravascular space longer when compared with the action of a crystalloid solution. C. The nurse should monitor for an anaphylactic reaction when these products are administered.

Which laboratory finding is consistent with acute coronary syndrome (ACS)? A. Troponin 3.2 ng/mL (3.2 mcg/L) B. C-reactive protein 13 mg/dL (130 mg/L) C. Triglycerides 400 mg/dL (4.52 mmol/L) D. Lipoprotein-a 18 mg/dL (0.64 mcmol/L)

A. Troponin 3.2 ng/mL (3.2 mcg/L)

The nurse is preparing to teach a client that metabolic syndrome can increase the risk for myocardial infarction (MI). Which signs of metabolic syndrome should the nurse include in the discussion? Select all that apply. A. Truncal obesity B. Hypercholesterolemia C. Elevated homocysteine levels D. Glucose intolerance E. Client taking losartan (Cozaar)

A. Truncal obesity B. Hypercholesterolemia D. Glucose intolerance E. Client taking losartan (Cozaar) (Blood pressure greater than 130/85 mm Hg or taking antihypertensive medication indicates metabolic syndrome.)

Which clients are at immediate risk for hypovolemic shock? Select all that apply. A. Unrestrained client in a motor vehicle collision (MVC) B. Construction worker C. Athlete D. Surgical intensive care unit (SICU) client E. 85-year-old with gastrointestinal (GI) virus

A. Unrestrained client in a motor vehicle collision (MVC) D. Surgical intensive care unit (SICU) client E. 85-year-old with gastrointestinal (GI) virus

The nurse knows that characteristics of acute coronary syndrome in clients include: SELECT ALL THAT APPLY A. Unusual fatigue B. High sodium C. Sleep disturbances D. SOB E. Chest discomfort

A. Unusual fatigue C. Sleep disturbances D. SOB E. Chest discomfort

What conditions below can result in an increased cardiac afterload? Select all that apply: A. Vasoconstriction B. Aortic stenosis C. Vasodilation D. Dehydration E. Pulmonary Hypertension

A. Vasoconstriction B. Aortic stenosis E. Pulmonary Hypertension

Commonalities of all Valve Disorders (4)

ALL on LEFT side All R sided HF Pulmonary congestion S/Sx Tx with diuretics

S/Sx of Aortic Stenosis

Angina Syncope During exercise Fatigue Peripheral cyanosis ** Can't breathe.

When drug therapy does not work with Cardiogenic shock?

Anigoplasty Intra-aortic balloon pump Impella CABG Percutaneous Coronary Intervention

P Wave represents?

Atrial Depolarization (Contraction) (SA Node)

S/Sx of Mitral Prolapse

Atypical chest pain, Dizziness, Syncope, Palpitations, A-Tach, V-Tach, Systolic click.

A client is newly diagnosed with a heart murmur and asks the nurse to explain what this means. What is the nurse's best response? A. "It is a term health care providers use to describe the efficiency of blood circulation." B. "It is a rushing sound that blood makes moving across narrowed places or defects." C. "It is the sound of the heart muscle stretching in an area of weakness." D. "It is the sound the heart makes when it has an increased workload."

B. "It is a rushing sound that blood makes moving across narrowed places or defects."

A client who is to undergo cardiac catheterization must be taught which essential information by the nurse? A. "Monitor the pulses in your feet when you get home." B. "Keep your affected leg straight for 2 to 6 hours." C. "Do not take your blood pressure medications on the day of the procedure." D. "Take your oral hypoglycemic with a sip of water on the morning of the procedure."

B. "Keep your affected leg straight for 2 to 6 hours."

A patient is on IV Norepinephrine for treatment of septic shock. Which statement is FALSE about this medication? A. "The nurse should titrate this medication to maintain a MAP of 65 mmHg or greater." B. "This medication causes vasodilation and decreases systemic vascular resistance." C. "It is used when fluid replacement is not unsuccessful." D. "It is considered a vasopressor."

B. "This medication causes vasodilation and decreases systemic vascular resistance." (This statement is FALSE because this medication causes vasoconstriction (not vasodilation) which INCREASES systemic vascular resistance.)

An RN and an LPN/LVN, both of whom have several years of experience in the intensive care unit, are caring for a group of clients. Which client is most appropriate for the RN to assign to the LPN/LVN? A. A client with pulmonary edema who requires hourly monitoring of pulmonary artery wedge pressures B. A client who was admitted with peripheral vascular disease and needs assessment of the ankle-brachial index C. A client who has intermittent chest pain and requires teaching about myocardial nuclear perfusion imaging D. A client with acute coronary syndrome who has just been admitted and needs an admission assessment

B. A client who was admitted with peripheral vascular disease and needs assessment of the ankle-brachial index

The nurse is evaluating a client's response to cardioversion. Which assessment would be the priority? A. BP B. Airway patency C. Oxygen flow rate D. LOC

B. Airway patency

Select all the fluid types below that are considered colloids? A. Fresh Frozen Plasma B. Albumin C. Normal Saline D. Lactated Ringer's E. Hetastarch F. Platelets

B. Albumin E. Hetastarch (A & F are blood products)

Which statement about diagnostic cardiovascular testing is correct? A. Complications of coronary arteriography include stroke, nonlethal dysrhythmias, arterial bleeding, and thromboembolism. B. An alternative to injecting a medium into the coronary arteries is intravascular ultrasonography. C. Holter monitoring allows periodic recording of cardiac activity during an extended period of time. D. The left side of the heart is catheterized first and may be the only side examined.

B. An alternative to injecting a medium into the coronary arteries is intravascular ultrasonography.

The nurse is caring for a group of clients who have sustained myocardial infarction (MI). The nurse observes the client with which type of MI most carefully for the development of left ventricular heart failure? A. Inferior wall B. Anterior wall C. Lateral wall D. Posterior wall

B. Anterior wall

The home health nurse visits a client with heart failure who has gained 5 pounds (2.3 kg) in the past 3 days. The client states, "I feel so tired and short of breath." Which action does the nurse take first? A. Assess the client for peripheral edema. B. Auscultate the client's posterior breath sounds. C. Notify the health care provider about the client's weight gain. D. Remind the client about dietary sodium restrictions.

B. Auscultate the client's posterior breath sounds.

Which teaching is essential for a patient who has had a permanent pacemaker inserted? A. Avoid talking on a cell phone. B. Avoid operating electrical appliances over the pacemaker. C. Avoid sexual activity. D. Do not take tub baths.

B. Avoid operating electrical appliances over the pacemaker.

A client with septic shock has been started on dopamine (Intropin) at 12 mcg/kg/min. Which response indicates a positive outcome? A. Hourly urine output 10 to 12 mL/hr B. Blood pressure 90/60 mm Hg and mean arterial pressure 70 mm Hg C. Blood glucose 245 mg/dL (13.6 mmol/L) D. Serum creatinine 3.6 mg/dL (318 mcmol/L)

B. Blood pressure 90/60 mm Hg and mean arterial pressure 70 mm Hg

Which medication, when given in heart failure, may improve morbidity and mortality? A. Dobutamine (Dobutrex) B. Carvedilol (Coreg) C. Digoxin (Lanoxin) D. Bumetanide (Bumex)

B. Carvedilol (Coreg)

The nurse is caring for a patient with unstable angina whose cardiac monitor shows ventricular tachycardia. Which action is appropriate to implement first? A. Defibrillate the patient at 200 joules. B. Check the patient for a pulse. C. Cardiovert the patient at 50 joules. D. Give the patient IV lidocaine.

B. Check the patient for a pulse. (If the patient has a pulse and is relatively stable, elective cardioversion or antidysrhythmic medications may be prescribed. The drug of choice for stable ventricular tachycardia with a pulse is amiodarone.If the patient is pulseless or nonresponsive, the patient is unstable and defibrillation is used and not cardioversion. Also, if the patient is pulseless, lidocaine may be given after defibrillation.)

Which signs and symptoms are seen with suspected pericarditis? Select all that apply. A. Squeezing, vise-like chest pain B. Chest pain relieved by sitting upright C. Chest and abdominal pain relieved by antacids D. Sudden-onset chest pain relieved by anti-inflammatory agents E. Pain in the chest described as sharp or stabbing

B. Chest pain relieved by sitting upright D. Sudden-onset chest pain relieved by anti-inflammatory agents E. Pain in the chest described as sharp or stabbing

A client has just returned from coronary artery bypass graft surgery. For which finding does the nurse contact the surgeon? A. Temperature 98.2°F (36.8°C) B. Chest tube drainage 175 mL last hour C. Serum potassium 3.9 mEq/L (3.9 mmol/L) D. Incisional pain 6 on a scale of 0 to 10

B. Chest tube drainage 175 mL last hour

How does the nurse in the cardiac clinic recognize that the client with heart failure has demonstrated a positive outcome related to the addition of metoprolol (Lopressor) to the medication regimen? A. Ejection fraction is 25%. B. Client states that she is able to sleep on one pillow. C. Client was hospitalized five times last year with pulmonary edema. D. Client reports that she experiences palpitations.

B. Client states that she is able to sleep on one pillow.

Which client would the charge nurse assign to a graduate RN who has completed 2 months of orientation to the coronary care unit? A. Client with a new diagnosis of heart failure who needs a pulmonary artery catheter inserted B. Client who has just arrived after a coronary arteriogram and has vital signs requested every 15 minutes C. Client with acute electrocardiographic changes who is requesting nitroglycerin for left anterior chest pain D. Client who has many questions about the electrophysiology studies (EPS) scheduled for today

B. Client who has just arrived after a coronary arteriogram and has vital signs requested every 15 minutes

Which client has pain most consistent with myocardial infarction (MI) requiring notification of the health care provider? A. Client with abdominal pain and belching B. Client with pressure in the mid-abdomen and profound diaphoresis C. Client with dyspnea on exertion (DOE) and inability to sleep flat who sleeps on four pillows D. Client with claudication and fatigue

B. Client with pressure in the mid-abdomen and profound diaphoresis

Which problem in the clients below best demonstrates the highest risk for hypovolemic shock? A. Client receiving a blood transfusion B. Client with severe ascites C. Client with myocardial infarction D. Client with syndrome of inappropriate antidiuretic hormone (SIADH) secretion

B. Client with severe ascites

The nurse in the coronary care unit is caring for a group of clients who have had a myocardial infarction. Which client does the nurse see first? A. Client with normal sinus rhythm and PR interval of 0.28 second B. Client with third-degree heart block on the monitor C. Client with dyspnea on exertion when ambulating to the bathroom D. Client who refuses to take heparin or nitroglycerin

B. Client with third-degree heart block on the monitor

The nurse in a coronary care unit interprets information from hemodynamic monitoring. The client has a cardiac output of 2.4 L/min. Which action would be taken by he nurse? A. No intervention is needed; this is a normal reading. B. Collaborate with the primary health care provider to administer a positive inotropic agent. C. Administer a STAT dose of metoprolol (Lopressor). D. Ask the client to perform the Valsalva maneuver.

B. Collaborate with the primary health care provider to administer a positive inotropic agent. (A positive inotropic agent will increase the force of contraction (stroke volume [SV]), thus increasing cardiac output (CO). Recall that SV × HR = CO (heart rate [HR]))

Your patient, who is post-op from a kidney transplant, has developed septic shock. Which statement below best reflects the interventions you will perform for this patient? A. Administer Norepinephrine before attempting a fluid resuscitation. B. Collect cultures and then administer IV antibiotics. C. Check blood glucose levels before starting any other treatments. D. Administer Drotrecogin Alpha within 48-72 hours.

B. Collect cultures and then administer IV antibiotics.

The nurse is concerned that a client who had myocardial infarction (MI) has developed cardiogenic shock. Which findings indicate shock? Select all that apply. A. Bradycardia B. Cool, diaphoretic skin C. Crackles in the lung fields D. Respiratory rate of 12 breaths/min E. Anxiety and restlessness F. Temperature of 100.4°F (38.0°C)

B. Cool, diaphoretic skin C. Crackles in the lung fields E. Anxiety and restlessness

A client with MI suddenly becomes tachycardiac, shows signs of air hunger, and begins coughing frothy, pink-tinged sputum. Which findings would the nurse anticipate when auscultating the client's breath sounds? A. Stridor B. Crackles C. Scattered rhonchi D. Diminished breath sounds

B. Crackles

The client in the cardiac care unit has had a large myocardial infarction. How does the nurse recognize onset of left ventricular failure? A. Urine output of 1500 mL on the preceding day B. Crackles in the lung fields C. Pedal edema D. Expectoration of yellow sputum

B. Crackles in the lung fields

Your patient's blood pressure is 72/56, heart rate 126, and respiration 24. The patient has a fungal infection in the lungs. The patient also has a fever, warm/flushed skin, and is restless. You notify the physician who suspects septic shock. You anticipate that the physician will order what treatment FIRST? A. Low-dose corticosteroids B. Crystalloids IV fluid bolus C. Norepinephrine D. 2 units of Packed Red Blood Cells

B. Crystalloids IV fluid bolus

A patient has a blood pressure of 220/140. The physician prescribes a vasodilator. This medication will? A. Decrease the patient's blood pressure and increase cardiac afterload B. Decrease the patient's blood pressure and decrease cardiac afterload C. Decrease the patient's blood pressure and increase cardiac preload D. Increase the patient's blood pressure but decrease cardiac output.

B. Decrease the patient's blood pressure and decrease cardiac afterload (The patient has a high systemic vascular resistance...as evidence by the patient's blood blood....there is vasoconstriction and this is resulting in the high blood pressure. Therefore, right now, the cardiac afterload is high because the ventricle must overcome this high pressure in order to pump blood out of the heart. If a vasodilator is given, it will decrease the blood pressure (hence the systemic vascular resistance) and this will decrease the cardiac afterload. The amount of the pressure the ventricle must pump against will decrease (cardiac afterload decrease) because the blood pressure will go down (hence the systemic vascular resistance).)

Which laboratory result is seen in late sepsis? A. Decreased serum lactate B. Decreased segmented neutrophil count C. Increased numbers of monocytes D. Increased platelet count

B. Decreased segmented neutrophil count

The nurse is monitoring a client with HTN who is taking Propranolol. Which assessment finding indicates a potential adverse complication associated with this medication? A. Report of infrequent insomnia B. Development of expiratory wheezes C. A baseline blood pressure of 150/80 followed by a blood pressure of 138/72 after 2 doses of medication D. A baseline resting HR of 88 followed by a resting HR of 72 after 2 doses of medication

B. Development of expiratory wheezes (This is a beta blocker)

The nurse is monitoring a client with HF who is taking Digoxin. Which findings are characteristic of digoxin toxicity? SATA A. Tremors B. Diarrhea C. Irritability D. Blurred vision E. Nausea and Vomiting

B. Diarrhea D. Blurred vision E. Nausea and Vomiting

Which atypical symptoms may be present in a female client experiencing myocardial infarction (MI)? Select all that apply. A. Sharp, inspiratory chest pain B. Dyspnea C. Dizziness D. Extreme fatigue E. Anorexia

B. Dyspnea C. Dizziness D. Extreme fatigue

Which of these factors contribute to the risk for cardiovascular disease? Select all that apply. A. Consuming a diet rich in fiber B. Elevated C-reactive protein levels C. Low blood pressure D. Elevated high-density lipoprotein (HDL) cholesterol level E. Smoking

B. Elevated C-reactive protein levels E. Smoking

The nurse plans to administer an antibiotic to a client newly admitted with septic shock. What action does the nurse take first? A. Administer the antibiotic immediately. B. Ensure that blood cultures were drawn. C. Obtain signature for informed consent. D. Take the client's vital signs.

B. Ensure that blood cultures were drawn.

Which risk factors are known to contribute to atrial fibrillation? Select all that apply. A. Use of beta-adrenergic blockers B. Excessive alcohol use C. Advancing age D. High blood pressure E. Palpitations

B. Excessive alcohol use C. Advancing age D. High blood pressure

After thrombolytic therapy, the nurse working in the cardiac catheterization laboratory would be alarmed to notice which sign? A. A 1-inch (2.5 cm) backup of blood in the IV tubing B. Facial drooping C. Partial thromboplastin time (PTT) 68 seconds D. Report of chest pressure during dye injection

B. Facial drooping (During and after thrombolytic administration, facial drooping may indicate intracranial bleeding, including changes in neurologic status.)

The nurse is caring for a patient with acute coronary syndrome (ACS) and atrial fibrillation who has a new prescription for metoprolol (Toprol). Which monitoring is essential when administering the medication? A. ST segment B. Heart rate C. Troponin D. Myoglobin

B. Heart rate

Select-all-that-apply: Which of the following are NOT typical signs and symptoms of pericarditis? A. Fever B. Increased pain when leaning forward C. ST segment depression D. Pericardial friction rub E. Radiating substernal pain felt in the left shoulder F. Breathing in relieves the pain

B. Increased pain when leaning forward C. ST segment depression F. Breathing in relieves the pain

Which characteristics place women at high risk for myocardial infarction (MI)? Select all that apply. A. Premenopausal B. Increasing age C. Family history D. Abdominal obesity E. Breast cancer

B. Increasing age C. Family history D. Abdominal obesity

How does the nurse caring for a client with septic shock recognize that severe tissue hypoxia is present? A. PaCO2 58 mm Hg B. Lactate 81 mg/dL (9.0 mmol/L) C. Partial thromboplastin time 64 seconds D. Potassium 2.8 mEq/L (2.8 mmol/L)

B. Lactate 81 mg/dL (9.0 mmol/L)

You're providing an in-service to new nurse graduates on the fluid treatment for hypovolemic shock. You ask the participants to list the types of crystalloid solutions used in hypovolemic shock. Which responses are CORRECT? Select all that apply: A. Albumin B. Lactated Ringer's C. Normal Saline D. Hetastarch

B. Lactated Ringer's C. Normal Saline

Which clinical symptoms in a postoperative client indicate early sepsis with an excellent recovery rate if treated? A. Localized erythema and edema B. Low-grade fever and mild hypotension C. Low oxygen saturation rate and decreased cognition D. Reduced urinary output and increased respiratory rate

B. Low-grade fever and mild hypotension

How does the nurse recognize that a positive outcome has occurred when administering plasma protein fraction (Plasmanate)? A. Urine output 20 to 30 mL/hr for the last 4 hours B. Mean arterial pressure (MAP) 70 mm Hg C. Albumin 3.5 g/dL (5.0 mcmol/L) D. Hemoglobin 7.6 g/dL (76 mmol/L)

B. Mean arterial pressure (MAP) 70 mm Hg

The nurse is caring for a client with an arterial line. How does the nurse recognize that the client is at risk for insufficient perfusion of body organs? A. Right atrial pressure is 4 mm Hg. B. Mean arterial pressure (MAP) is 58 mm Hg. C. Pulmonary artery wedge pressure (PAWP) is 7 mm Hg. D. PO2 is reported as 78 mm Hg.

B. Mean arterial pressure (MAP) is 58 mm Hg.

A client with a history of type 2 DM is admitted to the hospital with chest pain. The client is scheduled for a cardiac catheterization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure? A. Glipizide B. Metformin C. Rapaglinide D. Regular insulin

B. Metformin

A client comes to the emergency department with chest discomfort. Which action does the nurse perform first? A. Administers oxygen therapy B. Obtains the client's description of the chest discomfort C. Provides pain relief medication D. Remains calm and stays with the client

B. Obtains the client's description of the chest discomfort

The nurse receives a report that a patient with a pacemaker has experienced loss of capture. Which situation is consistent with this? A. The pacemaker spike falls on the T wave. B. Pacemaker spikes are noted, but no P wave or QRS complex follows. C. The heart rate is 42 beats/min, and no pacemaker spikes are seen on the rhythm strip. D. The patient demonstrates hiccups.

B. Pacemaker spikes are noted, but no P wave or QRS complex follows.

Prompt pain management with myocardial infarction is essential for which reason? A. The discomfort will increase client anxiety and reduce coping. B. Pain relief improves oxygen supply and decreases oxygen demand. C. Relief of pain indicates that the MI is resolving. D. Pain medication would not be used until a definitive diagnosis has been established.

B. Pain relief improves oxygen supply and decreases oxygen demand.

A patient in hypovolemic shock is receiving rapid infusions of crystalloid fluids. Which patient finding requires immediate nursing action? A. Patient heart rate is 115 bpm B. Patient experiences dyspnea and crackles in lung fields C. Patient is anxious D. Patient's urinary output is 35 mL/hr

B. Patient experiences dyspnea and crackles in lung fields

The nurse is reviewing the medical record of a client admitted with heart failure. Which laboratory result warrants a call to the primary health care provider by the nurse for further instructions? A. Calcium 8.5 mEq/L (4.25 mmol/L) B. Potassium 3.0 mEq/L (3.0 mmol/L) C. Magnesium 2.1 mEq/L (1 mmol/L) D. International normalized ratio (INR) of 1.0

B. Potassium 3.0 mEq/L (3.0 mmol/L)

Stroke volume plays an important part in cardiac output. Select all the factors below that influence stroke volume: A. Heart rate B. Preload C. Contractility D. Afterload E. Blood pressure

B. Preload C. Contractility D. Afterload

The nurse administers amiodarone (Cordarone) to a patient with ventricular tachycardia. Which monitoring by the nurse is necessary with this drug? Select all that apply. A. Respiratory rate B. QT interval C. Heart rate D. Heart rhythm E. Urine output

B. QT interval C. Heart rate D. Heart rhythm

A client with heart failure is taking furosemide (Lasix). Which finding concerns the nurse with this new prescription? A. Serum sodium level of 135 mEq/L (135 mmol/L) B. Serum potassium level of 2.8 mEq/L (2.8 mmol/L) C. Serum creatinine of 1.0 mg/dL (88.4 mcmol/L) D. Serum magnesium level of 1.9 mEq/L (0.95 mmol/L)

B. Serum potassium level of 2.8 mEq/L (2.8 mmol/L)

Which statement below best describes the term cardiac preload? A. The pressure the ventricles stretch at the end of systole. B. The amount the ventricles stretch at the end of diastole. C. The pressure the ventricles must work against to pump blood out of the heart. D. The strength of the myocardial cells to shorten with each beat.

B. The amount the ventricles stretch at the end of diastole.

All of this information is obtained by the nurse who is admitting a client for a coronary arteriogram. Which information is most important to report to the primary care provider before the procedure begins? A. The client has had intermittent substernal chest pain for 6 months. B. The client develops wheezes and dyspnea after eating crab or lobster. C. The client reports that a previous arteriogram was negative for coronary artery disease. D. The client has peripheral vascular disease, and the dorsalis pedis pulses are difficult to palpate.

B. The client develops wheezes and dyspnea after eating crab or lobster.

After a cardiac catheterization, the client needs to increase his or her fluid intake for which reason? A. NPO status will cause the client to be thirsty. B. The dye causes an osmotic diuresis. C. The dye contains a heavy sodium load. D. The pedal pulses will be more easily palpable.

B. The dye causes an osmotic diuresis.

A client begins therapy with lisinopril (Prinivil, Zestril). What does the nurse consider at the start of therapy with this medication? A. The client's ability to understand medication teaching B. The risk for hypotension C. The potential for bradycardia D. Liver function tests

B. The risk for hypotension

A patient with a severe infection has developed septic shock. The patient's blood pressure is 72/44, heart rate 130, respiration 22, oxygen saturation 96% on high-flow oxygen, and temperature 103.6 'F. The patient's mean arterial pressure (MAP) is 53 mmHg. Based on these findings, you know this patient is experiencing diminished tissue perfusion and needs treatment to improve tissue perfusion to prevent organ dysfunction. In regards to the pathophysiology of septic shock, what is occurring in the body that is leading to this decrease in tissue perfusion? Select all that apply: A. Absolute hypovolemia B. Vasodilation C. Increased capillary permeability D. Increased systemic vascular resistance E. Clot formation in microcirculation F. A significantly decreased cardiac output

B. Vasodilation C. Increased capillary permeability E. Clot formation in microcirculation

A client with myocardial infarction is developing cardiogenic shock. What condition should the nurse carefully assess the client for? A. Pulsus Paradoxus B. Ventricular dysrhythmias C. Rising DBP D. Falling CVP

B. Ventricular dysrhythmias

Select all the conditions below that increases a patient's risk for absolute hypovolemic shock: A. Burns B. Vomiting C. Long bone fracture D. Surgery E. Diarrhea F. Sepsis

B. Vomiting D. Surgery E. Diarrhea

A patient with a fever is lethargic and has a blood pressure of 89/56. The patient's white blood cell count is elevated. The physician suspects the patient is developing septic shock. What other findings indicate this patient is in the "early" or "compensated" stage of septic shock? Select all that apply: A. Urinary output of 60 mL over 4 hours B. Warm and flushed skin C. Tachycardia D. Bradypnea

B. Warm and flushed skin C. Tachycardia

A patient is receiving large amounts of fluids for aggressive treatment of hypovolemic shock. The nurse makes it PRIORITY to? A. Rapidly infuse the fluids B. Warm the fluids C. Change tubing in between bags D. Keep the patient supine

B. Warm the fluids (It is very important when giving large amount of fluids that the nurse ensures the fluids are warm. WHY? To prevent the patient from developing hypothermia.)

A patient with hypovolemic shock is given IV fluids. IV fluids will help _________ cardiac output by: A. decrease; decreasing preload B. increase, increasing preload C. increase, decreasing afterload D. decrease, increasing contractility

B. increase, increasing preload

The nurse is teaching a patient with a new permanent pacemaker. Which statement by the patient indicates a need for FURTHER discharge education? A. "I will be able to shower again soon." B. "I need to take my pulse every day." C. "I might trigger airport security metal detectors." D. "I no longer need my heart pills."

D. "I no longer need my heart pills."

Which statement by a client scheduled for a percutaneous transluminal coronary angioplasty (PTCA) indicates a need for FURTHER preoperative teaching? A. "I will be awake during this procedure." B. "I will have a balloon in my artery to widen it." C. "I must lie still after the procedure." D. "My angina will be gone for good."

D. "My angina will be gone for good."

A client is scheduled for an echocardiography today and asks why this test is being performed. What is the nurse's best response? A. "This procedure assesses for blockages within the coronary arteries." B. "This procedure will evaluate the oxygen saturation in your blood." C. "This procedure assesses for abnormal electrical impulses within the heart." D. "This procedure is a noninvasive way to assess the structure of the heart."

D. "This procedure is a noninvasive way to assess the structure of the heart."

The nurse is teaching a client about the purpose of electrophysiology studies (EPS). Which statement by the nurse reflects the most correct teaching? A. "This is a noninvasive test performed to assess your heart rhythm." B. "You will receive an injection of dobutamine (Dobutrex) and will walk on a treadmill to reveal whether you have coronary artery disease." C. "This is a painless test that is done to assess the structure of your heart using sound waves." D. "This test evaluates you for potentially fatal cardiac rhythms."

D. "This test evaluates you for potentially fatal cardiac rhythms."

In teaching patients at risk for bradydysrhythmias, what information does the nurse include? A. "Avoid potassium-containing foods." B. "Stop smoking and avoid caffeine." C. "Take nitroglycerin for a slow heartbeat." D. "Use a stool softener."

D. "Use a stool softener."

During discharge planning after admission for a myocardial infarction, the client says, "I won't be able to increase my activity level. I live in an apartment, and there is no place to walk." What is the nurse's best response? A. "You are right. Work on your diet then." B. "You must find someplace to walk." C. "Walk around the edge of your apartment complex." D. "Where might you be able to walk?"

D. "Where might you be able to walk?"

Which problem places a person at highest risk for septic shock? A. Kidney failure B. Cirrhosis C. Lung cancer D. 40% burn injury

D. 40% burn injury

A patient in septic shock is experiencing hyperglycemia. The patient is started on an insulin drip. A blood glucose goal for this patient would be: A. <110 mg/dL B. <80 mg/dL C. >200 mg/dL D. <180 mg/dL

D. <180 mg/dL

While conducting medication teaching on ace inhibitors for a newly diagnosed client with hypertension, the nurse emphasizes what possible side effect to report? A. Angioedema and seizures B. Frequent urination and nagging cough C. High sodium levels and nausea D. Angioedema and nagging dry cough

D. Angioedema and nagging dry cough

A patient is at risk for septic shock when a microorganism invades the body. Which microorganism is the MOST common cause of sepsis? A. Fungus B. Virus C. Parasite D. Bacteria

D. Bacteria

A client with hypovolemic shock has these vital signs: temperature 97.9°F (36.6°C); pulse 122 beats/min; blood pressure 86/48 mm Hg; respirations 24 breaths/min; urine output 20 mL for last 2 hours; skin cool and clammy. Which prescription order for this client does the nurse question? A. Dopamine (Intropin) 12 mcg/kg/min B. Dobutamine (Dobutrex) 5 mcg/kg/min C. Plasmanate 1 unit D. Bumetanide (Bumex) 1 mg IV

D. Bumetanide (Bumex) 1 mg IV (A diuretic such as bumetanide will decrease blood volume in a client who is already hypovolemic. This order must be questioned because this is not an appropriate action to expand the client's blood volume.The orders other than Bumetanide are appropriate for improving blood pressure in shock and do not need to be questioned.)

When caring for an obtunded client admitted with shock of unknown origin, which action does the nurse take first? A. Obtain IV access and hang prescribed fluid infusions. B. Apply the automatic blood pressure cuff. C. Assess level of consciousness and pupil reaction to light. D. Check the airway and respiratory status.

D. Check the airway and respiratory status.

The nurse is caring for a patient on a telemetry unit who has a regular heart rhythm and rate of 60 beats/min; a P wave precedes each QRS complex, and the PR interval is 0.20 second. Additional vital signs are as follows: blood pressure 118/68 mm Hg, respiratory rate 16 breaths/min, and temperature 98.8°F (37°C). All of these medications are available on the medication record. What action does the nurse take? A. Administer atropine. B. Administer digoxin. C. Administer clonidine. D. Continue to monitor.

D. Continue to monitor.

The nurse prepares to administer digoxin to a client with heart failure and notes the following information: Temperature: 99.8°F (37.7°C), Pulse: 48 beats/min and irregular, Respirations: 20 breaths/min, Potassium level: 3.2 mEq/L (3.2 mmol/L). What action does the nurse take? A. Give the digoxin; reassess the heart rate in 30 minutes. B. Give the digoxin; document assessment findings in the medical record. C. Hold the digoxin, and obtain a prescription for an additional dose of furosemide. D. Hold the digoxin, and obtain a prescription for a potassium supplement.

D. Hold the digoxin, and obtain a prescription for a potassium supplement.

The nurse is caring for a client with hemodynamic monitoring. Right atrial pressure is 8 mm Hg. The nurse anticipates which request by the primary health care provider? A. Saline infusion B. Morphine sulfate C. No treatment, continue monitoring D. Intravenous furosemide

D. Intravenous furosemide (The nurse expects that the primary health care provider will request intravenous furosemide be given to the client with a right atrial pressure of 8 mm Hg. Normal right atrial pressure is 0 to 5 mm Hg. The primary health care provider may prescribe furosemide, a diuretic, to reduce the fluid volume and right atrial pressure.)

Select the statement below that best describes cardiac afterload: A. It's the volume amount that fills the ventricles at the end of diastole. B. It's the volume the ventricles must work against to pump blood out of the body. C. It's the amount of blood the left ventricle pumps per beat. D. It's the pressure the ventricles must work against to open the semilunar valves so blood can be pumped out of the heart.

D. It's the pressure the ventricles must work against to open the semilunar valves so blood can be pumped out of the heart.

A patient in septic shock receives large amounts of IV fluids. However, this was unsuccessful in maintaining tissue perfusion. As the nurse, you would anticipate the physician to order what NEXT? A. IV corticosteroids B. Colloids C. Dobutamine D. Norepinephrine

D. Norepinephrine

Which action does the nurse delegate to experienced unlicensed assistive personnel (UAP) working in the cardiac catheterization laboratory? A. Assess preprocedure medications the client took that day. B. Have the client sign the consent form before the procedure is performed. C. Educate the client about the need to remain on bedrest after the procedure. D. Obtain client vital signs and a resting electrocardiogram (ECG).

D. Obtain client vital signs and a resting electrocardiogram (ECG).

A patient with severe pericarditis has developed a large pericardial effusion. The patient is symptomatic. The physician orders what type of procedure to help treat this condition? A. Pericardiectomy B. Heart catheterization C. Thoracotomy D. Pericardiocentesis

D. Pericardiocentesis (This is a procedure to remove excessive fluid from the pericardial sac.)

The nurse is caring for a client with heart failure in the coronary care unit. The client is now exhibiting signs of air hunger and anxiety. Which nursing intervention does the nurse perform first for this client? A. Determines the client's physical limitations B. Encourages alternate rest and activity periods C. Monitors and documents heart rate, rhythm, and pulses D. Positions the client to alleviate dyspnea

D. Positions the client to alleviate dyspnea

A client in sinus brady, with a HR of 45 and BP of 82/60 reports dizziness. Which intervention should the nurse anticipate will be prescribed? A. Administer Digoxin B. Defibrillate the client C. Continue to monitor the client D. Prepare for transcutaneous pacing

D. Prepare for transcutaneous pacing

The nurse is caring for a client 36 hours after coronary artery bypass grafting, with a priority problem of intolerance for activity related to imbalance of myocardial oxygen supply and demand. Which finding causes the nurse to terminate an activity and return the client to bed? A. Pulse 60 beats/min and regular B. Urinary frequency C. Incisional discomfort D. Respiratory rate 28 breaths/min

D. Respiratory rate 28 breaths/min

A patient being treated for infective endocarditis is complaining of very sharp radiating abdominal pain that goes to the left shoulder and back. As the nurse familiar with complications of infective endocarditis, what do you suspect is the cause of this patient finding? A. Renal embolic event B. Pulmonary embolic event C. Central nervous system embolic event D. Splenic embolic event

D. Splenic embolic event

___________ is the amount of blood pumped by the left ventricle with each beat. A. Cardiac output B. Preload C. Afterload D. Stroke volume

D. Stroke volume

The nurse is assessing a client with chest pain to evaluate whether the client is suffering from angina or myocardial infarction (MI). Which symptom is indicative of an MI? A. Substernal chest discomfort occurring at rest B. Chest pain brought on by exertion or stress C. Substernal chest discomfort relieved by nitroglycerin or rest D. Substernal chest pressure relieved only by opioids

D. Substernal chest pressure relieved only by opioids (Substernal chest pressure relieved only by opioids is typically indicative of MI.Substernal chest discomfort that occurs at rest is not necessarily indicative of MI, and it could be a sign of unstable angina. Both chest pain brought on by exertion or stress and substernal chest discomfort relieved by nitroglycerin or rest are indicative of angina.)

The nurse knows that which type of heart failure is characterized by a severely reduced ejection fraction in clients? A. Right sided B. Central C. Diastolic D. Systolic

D. Systolic

The nurse is caring for postoperative clients at risk for hypovolemic shock. Which condition represents an early symptom of shock? A. Hypotension B. Bradypnea C. Heart blocks D. Tachycardia

D. Tachycardia

A client admitted for heart failure has a priority problem of hypervolemia related to compromised regulatory mechanisms. Which assessment result obtained the day after admission is the best indicator that the treatment has been effective? A. The client has diuresis of 400 mL in 24 hours. B. The client's blood pressure is 122/84 mm Hg. C. The client has an apical pulse of 82 beats/min. D. The client's weight decreases by 2.5 kg.

D. The client's weight decreases by 2.5 kg.

How does the nurse recognize that atropine has produced a positive outcome for the patient with bradycardia? A. The patient states he is dizzy and weak. B. The nurse notes dyspnea. C. The patient has a heart rate of 42 beats/min. D. The monitor shows an increase in heart rate.

D. The monitor shows an increase in heart rate.

To validate that a client has had a myocardial infarction (MI), the nurse assesses for positive findings on which tests? A. Creatine kinase-MB fraction (CK-MB) and alkaline phosphatase B. Homocysteine and C-reactive protein C. Total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol D. Troponin

D. Troponin

A client has been admitted to the hospital with chest pain radiating down the left arm. The pain has been unrelieved by rest and antacids. Which test result best confirms that the client sustained a myocardial infarction (MI)? A. C-reactive protein of 1 mg/dL (10 mg/L) B. Homocysteine level of 13 mcmol/L C. Creatine kinase (CK) of 125 units/L D. Troponin of 5.2 ng/mL (5.2 mcg/L)

D. Troponin of 5.2 ng/mL (5.2 mcg/L)

The nurse is assessing a client with mitral stenosis who is to undergo a transesophageal echocardiogram (TEE) today. Which nursing action is essential? A. Auscultate the client's precordium for murmurs. B. Teach the client about the reason for the TEE. C. Reassure the client that the test is painless. D. Validate that the client has remained NPO.

D. Validate that the client has remained NPO.

The nurse is educating a group of women about the differences in symptoms of myocardial infarction (MI) in men versus those in women. Which information would be included? A. Men do not tend to report chest pain. B. Men are more likely than women to die after MI. C. Men more than women tend to deny the importance of symptoms. D. Women may experience extreme fatigue and dizziness as sole symptoms.

D. Women may experience extreme fatigue and dizziness as sole symptoms.

On physical assessment of a patient with pericarditis, you may hear what type of heart sound? A. S3 or S4 B. mitral murmur C. pleural friction rub D. pericardial friction rub

D. pericardial friction rub

Treatment for Ventricular Fibrillation

Debilitation, CPR

What is the function of Digoxin?

Decrease after load, Decrease HR, Improve SOB (Not the first line drug)

What happens with LV failure?

Decreased CO, Patient could go into A-fib

Functions of an ICD (implantable cardioverter-defibrillator)

Defibrillation of lethal arrhythmias

Endocarditis only affects the atrioventricular and semi-lunar valves in the heart. TRUE or FALSE?

FALSE (Endocarditis can affect not only the heart valves but the interventricular septum and chordae tendineae as well.)

The pericardium layer consists of a fibrous layer that is made up of two layers called the parietal and visceral layers. TRUE or FALSE?

FALSE (The pericardium layer consists of a fibrous layer and SEROUS layer that is made up of two layers called that parietal and visceral layers.)

S/Sx of Mitral Stenosis?

Fatigue, Dyspnea (on exertion), Coughing, Paroxysmal nocturnal dyspnea, Hemoptysis, palpitations, orthopnea, Hepatomegaly, Neck vein distention, Pitting edema, A fib, Rumbling/Apical diastolic murmur.

S/Sx of Mitral Regurgitation

Fatigue, Dyspnea (on exertion), Orthopnea, Palpitations, A-Fib, Neck Vein Distention, Pitting edema, High-pitched holosystolic murmur

What is the goal of management for Mitral Stenosis?

Get the workload off of the heart

Management of Cardiogenic Shock?

Goal: NEED FLUID OFF Oxygen Morphine If stable: Nitrates and Diuretics If unstable: Dopamine

Causes of Hypovolemic shock?

Hemorrhage, dehydration

Clinical signs of Right Ventricular MI? (5)

Hypotension Bradycardia N/V/Urge to defecate Edema Distended neck veins

S/sx of Hypovolemic shock

Increased HR Increased RR and Depth Increased thirst, LOC changes Decreased Urine output Cool or cold to touch Nausea Decreased bowel sounds Anxiety or agitation Decreasing Cardiac Output

Tall, peaked T waves indicate _______

Injury or Hyperkalemia

What is a percutaneous coronary intervention?

Invasive but nonsurgical performed WITHIN 90 MINUTES OF AN MI. · Before treatment, a left-sided catheterization with coronary angiogram is performed to assess vessels and left ventricular pumping. · It is performed to reduce the frequency and severity of discomfort for patients with angina and bridge to CABG if necessary. · It combines clot retrieval, coronary angioplasty, and stent placement

ST Depression (Lead II) indicates _______

Ischemia (there is not enough oxygen getting to the heart)

What is Central Venous Pressure?

Measures blood volume and venous pressure Reflects RIGHT SIDED filling pressure. Used to monitor fluid volume status.

What Valves are located on the Left side of the heart?

Mitral and Aortic

Post Procedure care of a Pacemaker? (4)

Monitor the incision Immobilize the arm Assist with PROM to prevent frozen shoulder. Keep the client from raising the arm higher than should height due to displacement of electrodes.

T Wave Inversion represents _____

Myocardial Ischemia

What are the cardiac biomarkers?

MyoglobinTroponin T and ICreatine kinase (CK)/Ck-MB

What is the etiology of Mitral Stenosis?

Narrowing of the mitral valve. Obstruction of flow from the LA to the LV LA dilates from increased blood volume. LV receives insufficient blood volume. Pulmonary congestion occurs d/t back up. Decreased CO, Decrease Preload. Patient could go into A-Fib

Treatment for Asystole

Non-shockable rhythm Epinephrine, Atropine, CPR

What is Regurgitation?

Occurs when a valve fails to close tightly. Also known as insufficiency/backflow because blood leaks back into the chambers as opposed to flowing forward.

What is Prolapse?

Occurs when the flaps bulge or flop back into one of the upper chambers

What is Stenosis?

Occurs when the flaps of the valves thicken, become stiffer, or even fuse together. As a result, there is not enough blood flowing through the valve. Narrowing

What does increased CVP indicate?

Overload

QRS follows the _________ wave

P wave

Pointed T wave may mean?

Pericarditis

A patient with an MI in the Posterior wall has an occlusion of the ________

RCA and/or the dorsal (back) of the Left Ventricle

What is the AV node?

Receives impulse from inter-nodal pathways and holds the signal before sending on to the Bundle of His. Inherent rate of 40-60 bpm Acts as back up when the SA node fails.

Who needs an ICD? (5)

Recommended for people who: Had a prior episode of sudden cardiac arrest Had a prior episode of V Fib Had at least one episode of V Tach Had a prior MI and have an increased r/f sudden cardiac arrest or cardiac death. Have hypertrophic cardiomyopathy

Indications for an ICD (implantable cardioverter-defibrillator)

Recurrent sustained ventricular tachycardia CHF with decreased EF (left side)

U Wave represents? Other reasons for U wave?

Repolarization of the purkinje fibers Reasons for: Bradycardia, Hypokalemia, Patients taking anti-arrhythmic drugs (Amiodarone)

What could Pulmonary congestion lead to?

Right sided HF

The J-Point is where the _______ begins

ST Segment

A patient with an MI in the Septal wall has an occlusion of the ________

Septal branches of the LAD

What is Pericarditis?

Swelling and irritation of the thin saclike membrane surrounding the heart (pericardium).

S/Sx of Aortic Regurgitation

Symptoms occur when the left ventricle fails · Dyspnea on exertion · Palpitations · Angina with diaphoresis · Fatigue Pulmonary congestion

Pulmonary and systemic vascular resistance both play a role with influencing cardiac afterload. TRUE or FALSE?

TRUE

Clinical signs of Left Ventricular MI? (3)

Tachycardia HTN --> Hypotension Dyspnea

Manifestations of Cardiogenic Shock?

Tachycardia Hypotension Systolic BP <90 or less than 30 mmHg of patient's baseline Cool, clammy skin Agitation, confused, restless Increased RR Crackles in the lung fields Decreased Urine output Continued chest pain Cardiac output <2 L/min

What is Systole?

The contraction phase of the heart. Valves close to prevent any black flow

What is the SA node?

The primary pacemaker of the heart (on the right side) Inherent rate of 60-100 bpm Represents atrial depolarization or firing (Excitability; P wave)

What is Diastole?

The resting phase of the heart. Valves act as a funnel to move blood FORWARD

P-R interval represents?

Travel time through the AV Node

What valves are located on the Right side of the heart?

Tricuspid and pulmonic

What is an intra-aortic balloon pump?

Used to improve tissue perfusion, decrease the workload on the heart and facilitate L ventricular ejection

Reasons for pacemakers?

Used to increase the HR with symptomatic bradycardia or blocks.

What is a CABG?

Used to replace the occluded coronary arteries with the patient's own venous/arterial blood vessels.

What is the function of CCBs?

Vasodilator. Decrease calcium into the heart. Decrease Oxygen demands. Decrease after load.

QRS Wave/Complex represents?

Ventricle Depolarization (Contraction)

T Wave represents?

Ventricle repolarization (relaxing)

What is Hypovolemic shock?

Volume depletion from the vascular space and loss of oxygen carrying capacity (decreased RBCs) Too little circulating blood volume causes the MAP to decrease and the body's total need for oxygen is not being met.

Treatment for Ventricular Tachycardia

We need to know if they have a pulse or not. If they have a pulse: Antidysrhythmic and cardioversion. If no pulse: CPR, Defibrillation.

Education for an ICD (implantable cardioverter-defibrillator)

When the ICD fires, it will hurt a little bit

The nurse is caring for a client following a CABG. Which assessment finding in the immediate postoperative period should be concerning? a. >250 mL chest tube drainage in 1 hour b. Current temperature of 101.3 c. Urine output 160 mL in the last 4 hours d. pH 7.35, PaCo2 45, PaO2 92

a. >250 mL chest tube drainage in 1 hour

Prophylactic antibiotics may be indicated to prevent infective endocarditis for "high-risk" individuals who: a. Are undergoing any dental procedure b. Are entering the third trimester of pregnancy c. Have acquired a viral respiratory tract infection d. Are exposed to human immunodeficiency virus.

a. Are undergoing any dental procedure (Anything invasive)

The most likely complication of myocardial infarction are: a. Arrhythmias and cardiogenic shock b. Nausea and vomiting c. Atrial fibrillation and edema d. Chest pain and dizziness

a. Arrhythmias and cardiogenic shock

On rounds you find that your patient has a blood glucose of 40 mg/dL. She is a known diabetic and is taking insulin. Which of the following mediations could be causing the low blood glucose? a. Atenolol (Tenormin) b. Albuterol (Proventil) c. Nitroglycerin (Transderm) d. Hydralazine (Apresoline)

a. Atenolol (Tenormin) (This is a Beta Blocker)

The nursing is caring for a client suspected of having heart failure. Diagnostic evaluation for a client in heart failure may include which of the following? SATA a. BNP >300 b. Decreased CO c. Altered ventricular filling d. Decreased myocardial contractility e. Increased ejection fraction

a. BNP >300 b. Decreased CO c. Altered ventricular filling d. Decreased myocardial contractility (The whole thing with HF is CO b/c the heart cannot fill or squeeze appropriately)

A nurse performs a head to toe physical assessment on a client who is admitted for the treatment of heart failure, which of the following assessment findings should signal to the nurse a possible exacerbation of the client's condition? a. Crackles b. BP 144/99 c. 600 mL of urine over 8 hours d. Glucose level of 159.

a. Crackles

A client in heart failure is prescribed a 2g sodium diet what is the important of the 2g Na diet? a. Decrease circulatory volume b. Improve coronary _____ c. Assist in weight loss d. Decrease incidence of arrythmias

a. Decrease circulatory volume

The primary causes of death in patients with heart transplants in the first year include: a. Infection and rejection b. Rejection and arrhythmias c. Arrhythmias and infection d. Fluid and electrolyte imbalance

a. Infection and rejection

A client with heart failure and atrial fibrillation is treated with Digoxin and a loop diuretic. To prevent possible complications of this combination of drugs, the nurse needs to: a. Monitor serum potassium levels b. Keep an accurate measure of intake and output c. Teach the client about dietary restriction of potassium d. Withhold the digitalis and notify the HCP if the heart rate is irregular.

a. Monitor serum potassium levels

A drug used in the management of a client with acute pulmonary edema that will decrease both preload and afterload and provide relief of anxiety is: a. Morphine b. Amiodarone c. Dopamine d. Adenosine

a. Morphine

A nurse is caring for a client following a coronary artery bypass graft. Which assessment finding in the immediate postoperative period should be most concerning to the nurse? a. No chest tube drainage in 1 hour when previously it was draining. b. Temperature 100.5F. c. Urine output of 160 mL in the last four hours. d. Arterial blood gases Ph. 7.36; PC02 42; HCO3 22; P02 95.

a. No chest tube drainage in 1 hour when previously it was draining.

The client is admitted to the coronary care unit with an ACS. Which should be the nurse's priority assessment? a. Pain b. Blood pressure c. Heart rate d. Respiratory rate

a. Pain

A client newly diagnosed with HTN asks the nurse what happens when uncontrolled HTN is prolonged. The nurse explains that a client with prolonged uncontrolled HTN is at risk for what health problem? a. Renal failure b. DVT c. OSA d. Right ventricular hypertrophy

a. Renal failure

The most important factor affecting time for treatment for a woman experience chest discomfort is. a. The ability to recognize her symptoms as being heart related. b. Calling her provider to ask for guidance. c. Researching online resources for signs and symptoms of a heart attack. d. Taking an 82mg aspirin and waiting at least an hour to see if the symptoms dissipate.

a. The ability to recognize her symptoms as being heart related.

Following a normal chest x-ray for a client who had cardiac surgery, a nurse receives an order to prepare to remove the chest tubes. Which intervention should the nurse plan to implement first? a. Auscultate the lung sounds. b. Administer 4mg of morphine intravenously. c. Prepare the bedside table with needed supplies. d. Turn the patient to the prone position.

b. Administer 4mg of morphine intravenously.

Oxygen therapy is recommended for all patients with ACS for the first hours after they become stable. The goal of oxygen therapy is to: a. Keep the oxygen saturation at 100%. b. Balance oxygen supply and demand. c. Reduce the workload on the heart. d. Prevent pulmonary edema.

b. Balance oxygen supply and demand.

A nurse is preforming a PA on a client suspected of being in HF, during auscultation HF would be suggested by what? SATA a. Thrill b. Crackles c. Ascites d. S3 e. Bilateral pedal edema

b. Crackles d. S3

A client with heart failure is at risk for poor CO related to inadequate perfusion to the kidneys, what will the kidneys do? (not worded correctly) a. Hyperkalemia b. Increased renin release c. Release of BNP d. Increase K+

b. Increased renin release

A patient with an MI of the Lateral wall of the left ventricle most likely has an occlusion(s) of the: a. Right marginal artery b. Left circumflex artery c. Left anterior descending artery d. Right anterior descending artery

b. Left circumflex artery c. Left anterior descending artery

The new onset of a gallop in a patient complaining of chest pain indicates what? a. Pulmonary embolism b. Myocardial infarction c. Papillary muscle rupture d. Cardiac tamponade

b. Myocardial infarction

The nurse is caring for the client immediately following insertion of a pacemaker via the right subclavian approach. Which intervention should the nurse include in the POC to prevent lead dislodgement? a. Inspect the incision for approximation and bleeding b. Prevent the right arm from going above the shoulder level c. Assist the client with using a walker when up d. Request a STAT chest x-ray upon returning from the procedure

b. Prevent the right arm from going above the shoulder level

A patient with a history of IV heroin use has acute infective endocarditis. The nurse closely assesses the patient for signs and symptoms of: a. Pneumonia b. Pulmonary emboli c. Increased cardiac output d. Decreased production of ADH (Vasopressin)

b. Pulmonary emboli

The nurse suspects cardiac tamponade in a patient with acute pericarditis based on the finding of: a. CVP reading 5 mmHg b. Pulsus paradoxus c. Mitral Valve murmur d. Cyanosis of the lower extremities

b. Pulsus paradoxus

The most common cause of mitral valve stenosis is: a. Myocarditis b. Rheumatic heart disease/Congenital anomalies c. MRSA d. Subacute infective endocarditis

b. Rheumatic heart disease/Congenital anomalies

Chest pain that is not relieved by rest and nitroglycerin is called: a. Stable angina b. Unstable angina c. Prinzmetal's angina d. Systolic angina

b. Unstable angina

The patient is admitted for unstable angina. The patient is currently asymptomatic, and all vital signs are stable. Which position does the nurse place the patient in? a. Supine b. Sitting up in bed c. Any position of comfort d. Tripod

c. Any position of comfort

The nurse caring for clients on a medical unit thinks she hears a murmur while assessing the client. After determining that no other HCP have documented a murmur, what action should the nurse implement next? a. Document the finding in the client's chart b. Notify the HCP c. Ask the client if there is a history of a murmur d. Obtain an order for a 12 lead EKG.

c. Ask the client if there is a history of a murmur

While take taking vital signs on your patient, you find a heart rate of 144 that is irregularly, irregular, blood pressure of 143/76 and respiration rate of 19/minute. The most likely arrhythmia associated with these findings are. a. Ventricular tachycardia b. Normal sinus rhythm c. Atrial fibrillation d. Atrial flutter

c. Atrial fibrillation

A patient hospitalized with mitral stenosis has a nursing diagnosis of Activity Intolerance r/t insufficient oxygen. An appropriate nursing intervention for this patient is to: a. Monitor ECG to assess cardiac output b. Maintain on bed rest to reduce tissue oxygen demands c. Avoid strenuous activities that increase heart rate d. Use a semi-Fowler's position to decrease venous return and increase respiratory excursion.

c. Avoid strenuous activities that increase heart rate

Teaching the patient with Rheumatic Fever about the disease, the nurse explains that rheumatic fever is: a. A E. Coli Infection b. A viral infection of endocardium and valves c. Beta-Hemolytic Streptococcal infection d. Frequently triggered by immunosuppressive therapy

c. Beta-Hemolytic Streptococcal infection

Which of the following sets of conditions is an indication that a client with a history of left-sided heart failure is developing pulmonary edema? a. Distended jugular veins and wheezing b. Dependent edema and anorexia c. Course crackles and tachycardia d. Hypotension and bradycardia

c. Course crackles and tachycardia

The nurse is assessing the client with an anterior wall MI. The nurse should add decreased cardiac output in the client's POC when which finding is noted? a. Pain radiates up the left arm to the neck b. Presence of lower leg and ankle edema c. Crackles auscultated in both lung bases d. Harsh breath sounds over lung lobes

c. Crackles auscultated in both lung bases (We are worried about HF)

Calcium-channel blockers have which of the following functions? a. Increase vascular tone. b. Increase the velocity of the SA node. c. Decrease oxygen demands of the heart. d. Increase cerebral oxygenation.

c. Decrease oxygen demands of the heart.

The best diagnostic test to use to evaluate cardiac status during the first hours of chest pain is: a. Hemoglobin A1C b. Cardiac catheterization c. Electrocardiogram d. Systolic and diastolic blood pressure

c. Electrocardiogram

The nurse caring for a patient scheduled for a percutaneous balloon valvuloplasty understand that this procedure: a. Is the treatment of choice for combined aortic stenosis and aortic regurgitation b. Involves open heart cardiopulmonary bypass surgery c. Is recommended for patients who are poor candidates for more extensive valvular surgery d. Is a last resort treatment when other valvular repair procedures have not been effective.

c. Is recommended for patients who are poor candidates for more extensive valvular surgery

A patient with an MI of the anterior wall of the left ventricle most likely has an occlusion of the: a. Right marginal artery b. Left circumflex artery c. Left anterior descending artery d. Right anterior descending artery

c. Left anterior descending artery

A client with a tricuspid valve disorder will have impaired blood flow between the: a. Vena cava and right atrium b. Left atrium and left ventricle c. Right atrium and right ventricle d. Right ventricle and pulmonary artery

c. Right atrium and right ventricle

The nurse plans care for the client with dilated cardiomyopathy based on the knowledge that: a. Family members may be at risk because of the infectious nature of the disease b. Nursing management of the disorder focuses on treatment of the underlying cause c. The prognosis of the client is poor, and emotional support is a high priority of care. d. The condition may be successfully treated with surgical intervention.

c. The prognosis of the client is poor, and emotional support is a high priority of care. (The atria and ventricles are enlarged)

The client diagnosed with aortic stenosis scheduled for an echo tells the nurse, "I am scared. What will they do during the test?" Which statement is the best response? a. "You're scared? Why? It's not big procedure. Tell me what you are afraid of" b. "The doctor will insert a catheter into your throat to look at your heart." c. "I think you should talk with the doctor about your fears." d. "Sound waves will be used to determine how your heart is working."

d. "Sound waves will be used to determine how your heart is working."

The nurse observes sinus tachycardia with new-onset ST segment elevation on the EKG monitor of the client reporting chest pain. Which should be the nurse's priority intervention? a. Draw blood for cardiac enzymes STAT b. Call the cardiac catheterization lab c. Apply 1 inch of nitroglycerin paste topically d. Apply 2 liters of oxygen via nasal cannula

d. Apply 2 liters of oxygen via nasal cannula (We need to get more oxygen to the heart)

The client, returning from a coronary catheterization in the femoral artery approach was used, sneezes. Which should be the nurses' priority intervention? a. Palpate pedal pulses b. Measure vital signs c. Assess for pain d. Check the insertion site

d. Check the insertion site

The nurse observes that the client, 3 days post MI is fatigued. Upon assessment, the client is dyspneic, has sinus tachycardia, and generalized edema. Which action is most appropriate? a. Administer high-flow oxygen b. Encourage the client to rest more during the day c. Continue to monitor the heart rhythm d. Compare the client's admission weight with current weight

d. Compare the client's admission weight with current weight

What does decreased CVP indicate?

hypovolemia and shock

Symptoms and Characteristics of Marfan's Syndrome?

· Arched palate (roof of the mouth) · Scoliosis · Flat feet · Problems with the eyes · Problems w/ Cardiovascular & Nervous System · Problem w/ Skin · Problem w/ lungs · Affects the skeleton, heart, and blood vessels ELONGATED! Chest is sunken in!