NU 424 Cardiac PrepU
Stimulating the client's gag reflex Placing the client's face in cold water Performing carotid massage
A 26-year-old client, who has been diagnosed with paroxysmal supraventricular tachycardia (PSVT), is treated in the emergency department. The client is experiencing occasional runs of PSVT lasting up to several minutes at a time. During these episodes, the client becomes lightheaded but does not lose consciousness. Which maneuver(s) may be used to interrupt the client's atrioventricular nodal reentry tachycardia (AVNRT)? Select all that apply. Placing the client's face in cold water Stimulating the client's gag reflex Instructing the client to breathe deeply Performing carotid massage Instructing the client to vigorously exercise
Heparin
A 43-year-old male came into the emergency department where you practice nursing and was diagnosed with atrial fibrillation. It's now 48 hours since his admittance and the dysrhythmia persists. Which of the following medications will the client's healthcare provider most likely order? Flecainide (Tambocor) Warfarin (Coumadin) Dabigatran (Pradaxa) Heparin
"The medication you were prescribed may cause sexual dysfunction; are you experiencing this side effect?"
A 55-year-old client newly diagnosed with hypertension returns to the physician's office for a routine follow-up appointment after several months of treatment with metoprolol. During the initial assessment, the nurse records the client's blood pressure (BP) as 180/90 mm Hg. The client states that the medicatoin is not taken as prescribed. Which is the best response by the nurse? "Be certain to discuss your noncompliance with your medication regimen with the physician." "Your hypertension must be treated with medications; you need to take your metoprolol every day." "It is very important for you to take your medication as prescribed, or you could experience a stroke." "The medication you were prescribed may cause sexual dysfunction; are you experiencing this side effect?"
"Practice meticulous foot care."
A client complains of leg pain brought on by walking several blocks — a symptom that first arose several weeks earlier. The client's history includes diabetes mellitus and a two-pack-per-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and orders pentoxifylline (Trental), 400 mg three times daily with meals. Which instruction concerning long-term care should the nurse provide? "Reduce your level of exercise." "Consider cutting down on your smoking." "Practice meticulous foot care." "See the physician if complications occur."
Pericarditis
A client describes chest pain as sharp, substernal of intermittent duration, and radiating to the arms and back. The client says the pain increases with inspiration and swallowing and is alleviated when sitting upright. What does the nurse suspect the client may be experiencing? A panic attack Angina pectoris A dissecting aorta Pericarditis
Improved quality of life
A client diagnosed with a myocardial infarction (MI) has begun an active rehabilitation program. The nurse recognizes which overall goal as a focus of rehabilitation for a client who has had an MI? Improved quality of life Return to work and the lifestyle experienced before the illness Prevention of another cardiac event Limit to the effects and progression of atherosclerosis
Improvement in quality of life
A client diagnosed with a myocardial infarction (MI) is being moved to the rehabilitation unit for further therapy. Which statement reflects a goal of rehabilitation for the client with an MI? Improvement in quality of life Ability to return to work and a preillness functional capacity Limitation of the effects and progression of atherosclerosis Prevention of another cardiac event
Avoid over-the-counter decongestants and cold remedies. Do not smoke, or stop smoking. Wear gloves to protect hands from injury when performing tasks.
A client has been diagnosed with Raynaud's disease. Which self-care strategies minimize risks associated with this disease? Select all that apply. Avoid over-the-counter decongestants and cold remedies. Wear gloves to protect hands from injury when performing tasks. Do not smoke, or stop smoking. Limit activities that place stress on the ulnar nerve. Refrain from going outdoors in cold weather.
an old MI
A client has had a 12-lead ECG completed as part of an annual physical examination. The nurse notes an abnormal Q wave on an otherwise unremarkable ECG. The nurse recognizes that this finding indicates an evolving MI. variant angina. a cardiac dysrhythmia. an old MI.
Avoid large magnetic fields. Carry a card identifying yourself as a pacemaker recipient.
A client has had a pacemaker inserted and is ready for discharge. The nurse is providing education about pacemaker safety. Which of the following are items that the nurse will be sure to address? Choose all that apply. Monitor your pulse once a month. Sit at least 12 feet from television sets. Carry a card identifying yourself as a pacemaker recipient. Do not spend time near a microwave oven. Avoid large magnetic fields.
experiences recurrent episodes of atrial flutter.
A client has had an automatic implanted cardioverter defibrillator (AICD) implanted. The nurse explains the purpose and benefits of the AICD to the client's family. The least likely reason for the client's AICD implantation is that the client: experiences recurrent episodes of ventricular tachycardia. experiences recurrent episodes of atrial flutter. has survived at least one episode of cardiac arrest with ventricular origin. is at risk for death due to structural cardiac disease with poor ventricular function.
10 minutes
A client has just arrived in the ER with a possible myocardial infarction (MI). The electrocardiogram (ECG) should be obtained within which time frame of arrival to the ER? 20 minutes 15 minutes 5 minutes 10 minutes
Lose weight. Manage stress effectively.
A client has just received a diagnosis of hypertension after the completion of diagnostics. What can the client do to decrease the consequences of hypertension? Select all that apply. Lose weight. Use smokeless tobacco. Get plenty of rest. Manage stress effectively.
Adjust the IV infusion.
A client has started to exhibit dangerous PVCs in the cardiac postoperative unit. The client has been given a bolus of lidocaine and is under continuous IV infusion, but serious side effects, including hypotension during administration, could occur. What should the nurse be ready to do? Adjust the IV infusion. Call for the doctor and just wait. Administer additional lidocaine. Prepare for defibrillation.
Hoarse voice and difficulty swallowing
A client in the ED has a 5-cm thoracic aortic aneurysm that was discovered during a routine chest x-ray. When obtaining the client's history, which symptoms will it be most important for the nurse to ask about? Back or lumbar pain Changes in bowel and bladder habits Hoarse voice and difficulty swallowing Abdominal swelling and tenderness
Dipyridamole
A client is being scheduled for a stress test. The client is unable to exercise during the test. The nurse would include information about which medication used for pharmacologic stress testing? Dipyridamole Lanoxin Cardiolite Thallium 201
lowers resistance, reduces cardiac workload, and decreases myocardial oxygen demand.
A client is experiencing an acute myocardial infarction (MI) and I.V. morphine is ordered. The nurse knows that morphine is given because it: increases venous return, lowers resistance, and reduces cardiac workload. eliminates pain, reduces cardiac workload, and increases myocardial contractility. lowers resistance, reduces cardiac workload, and decreases myocardial oxygen demand. raises the blood pressure, lowers myocardial oxygen demand, and eliminates pain.
A. atrial cell stimulation B. AV node C. bundle of HIS D. bundle branches E. Purkinje fibers
A client is experiencing an irregular heartbeat. The client asks the nurse how a heartbeat occurs. The nurse explains the conduction system of the heart beginning with the sinoatrial node (SA node). Place the conduction sequence of the heart in order beginning with the SA node. Use all options. A. atrial cell stimulation B. AV node C. bundle of HIS D. bundle branches E. Purkinje fibers
Decrease in cardiac contractility
A client is prescribed quinine for treatment of moderate depression of depolarization. Which sign indicates the drugs' effectiveness in the client's treatment? Hypertension with IV administration. Shortened QT segment Decreased QRS duration of about 40% from baseline Decrease in cardiac contractility
Depression
A client is recovering from coronary artery bypass graft (CABG) surgery. During discharge preparation, the nurse should advise the client and family members to expect which common symptom that typically resolves spontaneously? Dizziness Depression Memory lapses Ankle edema
Administer moderate sedation IV and analgesic medication as prescribed
A client is scheduled for an elective electrical cardioversion for a sustained dysrhythmia lasting for 24 hours. Which intervention is necessary for the nurse to implement prior to the procedure? Administer the prescribed digitalis to the client before the scheduled procedure Administer anticoagulant therapy as prescribed prior to the procedure Administer moderate sedation IV and analgesic medication as prescribed Maintain the client on NPO status for 8 hours prior to the procedure
Destruction of specific cardiac cells
A client is scheduled for catheter ablation therapy. When describing this procedure to the client's family, the nurse should address which aspect of the treatment? Resetting of the heart's contractility Destruction of specific cardiac cells Clearance of partially occluded coronary arteries Correction of structural cardiac abnormalities
Initiate transcutaneous pacing
A client is treated in the intensive care unit (ICU) following an acute myocardial infarction (MI). During the nursing assessment, the client reports shortness of breath and chest pain. In addition, the client's blood pressure (BP) is 100/60 mm Hg with a heart rate (HR) of 53 bpm, and the electrocardiogram (ECG) tracing shows more P waves than QRS complexes. Which action should the nurse complete first? Administer 1 mg of IV atropine Prepare for defibrillation Obtain a 12-lead ECG Initiate transcutaneous pacing
12-lead ECG
A client presents to the emergency department reporting chest pain. Which order should the nurse complete first? Troponin level 2 L oxygen via nasal cannula 12-lead ECG Aspirin 325 mg orally
Failure to capture
A client receives a pacemaker to treat a recurring arrhythmia. When monitoring the cardiac rhythm strip, the nurse observes extra pacemaker spikes that don't precede a beat. Which condition should the nurse suspect? Asystole Failure to sense Failure to capture Failure to pace
How would you describe your symptoms? Are you allergic to any medications or foods? How did your mother die?
A client reports chest pain. Which questions related to the client's history are most important to ask? Select all that apply. How would you describe your symptoms? Are you allergic to any medications or foods? How did your mother die? Do you have any children?
Remove the transdermal patch at night and reapply in the morning. Store the patch in its original container when not in use.
A client with CAD has been prescribed a transdermal nitroglycerin patch. What instructions should the nurse provide to to the client? Select all that apply. Remove the transdermal patch at night and reapply in the morning. Cover the patch in plastic wrap after applying. Seek emergency treatment if flushing or nausea occurs. Store the patch in its original container when not in use.
anterior.
A client with a myocardial infarction (MI) develops pulmonary crackles and dyspnea. A chest X-ray shows evidence of pulmonary edema. What type of MI did this client have? anterior. lateral. posterior. inferior.
Tachycardia
A client with aortic valve regurgitation is asking about their disease process. What would you, as the nurse, tell the client is the first sign of aortic valve regurgitation? Left-sided heart failure Pain Dysrhythmias Tachycardia
Carvedilol
A client with chest pain arrives in the emergency department and receives nitroglycerin, morphine, oxygen, and aspirin. The health care provider diagnoses acute coronary syndrome. When the client arrives on the unit, vital signs are stable and the client does not report any pain. In addition to the medications already given, which medication does the nurse expect the health care provider to order? Digoxin Carvedilol Nitroprusside Furosemide
4 to 6 hours
A client with suspected acute myocardial infarction is admitted to the coronary care unit. To help confirm the diagnosis, the physician orders serial enzyme tests. Increased serum levels of the isoenzyme creatinine kinase of myocardial muscle (CK-MB), found only in cardiac muscle, can be detected how soon after the onset of chest pain? 12 to 18 hours 4 to 6 hours 2 to 3 hours 30 minutes to 1 hour
hypertensive heart disease
A client's chart indicates an S4 heart sound, and is scheduled for a cardiac workup. The nurse is aware that this client may have which cardiac condition? pericarditis heart failure hypertensive heart disease diseased heart valves
The cycle of depolarization and repolarization
A client's declining cardiac status has been attributed to decreased cardiac action potential. Interventions should be aimed at restoring what aspect of cardiac physiology? The cycle of depolarization and repolarization The time between the contraction of the atria and the contraction of the ventricles The cycle of the firing of the AV node and the contraction of the myocardium The time it takes from the firing of the SA node to the contraction of the ventricles
Pneumothorax Infection Air embolism
A critical care nurse is caring for a client with a hemodynamic monitoring system in place. For what complications should the nurse assess? Select all that apply. Bronchospasm Atelectasis Pneumothorax Infection Air embolism
D. Left ventricular preload
A critical care nurse is caring for a client with a pulmonary artery catheter in place. What does this catheter measure that is particularly important in critically ill clients? A. Pulmonary artery pressure B. Pulmonary artery systolic pressure C. Right ventricular afterload D. Left ventricular preload
Keeping the legs in a neutral or dependent position
A home health nurse is teaching a client with peripheral arterial disease ways to improve circulation to the lower extremities. The nurse encourages which of the following in teaching? Elevation of the legs above the heart Use of antiembolytic stockings Keeping the legs in a neutral or dependent position Application of ace wraps from the toe to below the knees
A client with poorly controlled type 1 diabetes who is a smoker
A medical nurse has admitted four clients over the course of a 12-hour shift. For which client would assessment of ankle-brachial index (ABI) be most clearly warranted? A client who has peripheral edema secondary to chronic heart failure A client who has community-acquired pneumonia and a history of COPD An older adult client who has a diagnosis of unstable angina A client with poorly controlled type 1 diabetes who is a smoker
An abdominal pulsatile mass A systolic bruit Lower abdominal pain Low back pain
A nurse assesses a patient for a possible abdominal aortic aneurysm (AAA). Which of the following signs would the nurse recognize as positive indicators? Select all that apply. An abdominal pulsatile mass A systolic bruit Lower abdominal pain Hypertension Low back pain Radiating chest pain
Metabolic syndrome
A nurse completed a physical exam for an insurance company. The nurse noted a cluster of abnormalities that she knew was considered a major risk factor for coronary artery disease. Choose that condition. Diabetes mellitus Congestive heart failure Hypolipidemia Metabolic syndrome
140/90 or lower
A nurse educator is providing information to a small group of clients about hypertension. A participant asks what her target blood pressure should be. The nurse is aware of the target goals of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). Which of the following reflects the goal for blood pressure readings for people without co-morbidities? 145/95 or lower 140/90 or lower 135/80 or lower 135/85 or lower
Severe, incapacitating chest pain
A nurse is assigned to care for a recently admitted client who has been diagnosed with refractory angina. What symptom will the nurse expect the client to exhibit? Severe, incapacitating chest pain Pain that may occur at rest, but the threshold for pain is lower than expected Predictable and consistent pain that occurs on exertion and is relieved by rest Pain that occurs more frequently and lasts longer than the pain usually seen with stable angina
Procainamide
A nurse is caring for a client who is on a continuous cardiac monitor. When evaluating the client's rhythm strip, the nurse notes that the QRS interval has increased from 0.08 second to 0.14 second. Based on this finding, the nurse should withhold continued administration of which drug? Procainamide Metoprolol Propafenone Verapamil
Thready pulse
A nurse is caring for a dying client following myocardial infarction. The client is experiencing apnea with a falling blood pressure of 60 per palpation. Which documentation of pulse quality does the nurse anticipate? A pulse deficit Bounding pulse Thready pulse Weak pulse
A. Feet and ankles
A nurse is completing a head to toe assessment on a client diagnosed with right-sided heart failure. To assess peripheral edema, which of the following areas should be examined? A. Feet and ankles B. Shoulders and elbows C. Under the sacrum D. Lips and earlobes
wet lung sounds wheezes
A nurse is conducting procedures to determine the extent of a client's left-sided heart failure. What adventitious lung sounds would the nurse expect to hear during auscultation of the lungs to support the diagnosis? Select all that apply. labor wet lung sounds stridor wheezes
Relieves pain Decreases ischemia Dilates blood vessels Reduces myocardial oxygen consumption
A nurse is educating a client with coronary artery disease about nitroglycerin administration. The nurse tells the client that nitroglycerin has what actions? Select all that apply. Relieves pain Reduces myocardial oxygen consumption Decreases ischemia Decreases the urge to use tobacco Dilates blood vessels
Irregularly irregular heart rate
A nurse is performing a cardiac assessment on an elderly client. Which finding warrants further investigation? Orthostatic hypotension Irregularly irregular heart rate Fourth heart sound (S4) Increased PR interval
Use alcohol in moderation.
A nurse is teaching a client about maintaining a healthy heart. The nurse should include which point in her teaching? Exercise one or two times per week. Use alcohol in moderation. Smoke in moderation. Consume a diet high in saturated fats and low in cholesterol.
African-American descent Family history of coronary heart disease Elevated C-reactive protein Age greater than 45 years for men
A nurse is teaching about risk factors that increase the probability of heart disease to a community group. Which risk factors will the nurse include in the discussion? Select all that apply. African-American descent Body mass index (BMI) of 23 Family history of coronary heart disease Elevated C-reactive protein Age greater than 45 years for men
Renal failure
A nurse should be prepared to manage complications following abdominal aortic aneurysm resection. Which complication is most common? Graft occlusion Hemorrhage and shock Enteric fistula Renal failure
Preload is reduced.
A patient diagnosed with coronary artery disease is being placed on nitroglycerin. The nurse understands that the premise behind administration of nitrates in this patient population includes which of the following? More blood returns to the heart. Preload is reduced. It functions has a vasoconstrictor. It increases myocardial oxygen consumption.
Cardiac tamponade
A patient has had cardiac surgery and is being monitored in the intensive care unit (ICU). What complication should the nurse monitor for that is associated with an alteration in preload? Elevated central venous pressure Cardiac tamponade Hypertension Hypothermia
Catheter ablation therapy
A patient has had several episodes of recurrent tachydysrhythmias over the last 5 months and medication therapy has not been effective. What procedure should the nurse prepare the patient for? Insertion of an ICD Insertion of a permanent pacemaker Maze procedure Catheter ablation therapy
Computed tomography Transesophageal echocardiography X-ray
A patient is suspected to have a thoracic aortic aneurysm. What diagnostic test(s) does the nurse anticipate preparing the patient for? (Select all that apply.) Computed tomography Transesophageal echocardiography X-ray Electrocardiogram (ECG) Electroencephalogram
Creatinine Blood urea nitrogen (BUN)
A patient with hypertension is waking up several times a night to urinate. The nurse knows that what laboratory studies may indicate pathologic changes in the kidneys due to the hypertension? (Select all that apply.) Complete blood count (CBC) AST and ALT Creatinine Blood urea nitrogen (BUN) Urine for culture and sensitivity
Myoglobin
After 2-hour onset of acute chest pain, the client is brought to the emergency department for evaluation. Elevation of which diagnostic findings would the nurse identify as suggestive of an acute myocardial infarction at this time? WBC (white blood cell) count Troponin I Myoglobin C-reactive protein
B. endocardial fibrosis C. increased size of the left atrium
Age-related changes associated with the cardiac system include which conditions? Select all that apply. A. myocardial thinning B. endocardial fibrosis C. increased size of the left atrium D. increase in the number of SA node cells
Death
An African American client at the clinic has just been diagnosed with essential hypertension. The client tells the nurse that they do not take medicine. What would the nurse tell the client is the most serious consequence of chronic hypertension? Blindness Stroke Death Myocardial infarction
Indigestion Nausea
An ED nurse is assessing a 71-year-old female client for a suspected MI. When planning the assessment, the nurse should be cognizant of what signs and symptoms of MI that are particularly common in female clients? Select all that apply. Indigestion Nausea Chest pain Shortness of breath Anxiety
an expected part of the aging process.
An client who has been diagnosed with arteriosclerosis is confused by what this means. The nurse explains that arteriosclerosis is: a vascular occlusive disease. high level of blood fat. a condition in which the lumen of arteries fill with scar tissue. an expected part of the aging process.
Leads V3 and V4
An electrocardiogram (ECG) taken during a routine checkup reveals that a client has had a silent myocardial infarction. Changes in which leads of a 12-lead ECG indicate damage to the left ventricular septal region? Leads V3 and V4 Leads I, aVL, V5, and V6 Leads II, III, and aVF Leads V1 and V2
transesophageal echocardiography
An obese client describes symptoms of palpitations, chronic fatigue, and dyspnea on exertion to the cardiologist. Upon completing the examination, the cardiologist schedules a procedure to confirm the suspected diagnosis. What diagnostic procedure would the nurse expect to be prescribed? transesophageal echocardiography radionuclide angiography chest radiograph electrocardiography
Balloon valvuloplasty
Aortic stenosis remains asymptomatic for several decades. However, once a client becomes symptomatic for aortic stenosis, life expectancy without further treatment is only 2 to 3 years. What is the treatment of choice for symptomatic aortic stenosis? Balloon valvuloplasty Cardiac catheterization Balloon angioplasty Cardiac graft procedure
30
Approximately what percentage of adults in the United States have hypertension? 20 30 40 50
The defibrillator won't deliver a shock if the synchronizer switch is turned off.
Before using a defibrillator to terminate ventricular fibrillation, a nurse should check the synchronizer switch. Why is this check so important? The shock must be synchronized with the client's T wave. The defibrillator won't deliver a shock if the synchronizer switch is turned off. The defibrillator won't deliver a shock if the synchronizer switch is turned on. The delivered shock must be synchronized with the client's QRS complex.
With thiazide diuretics, monitor serum potassium concentration. Direct vasodilators may cause headache and tachycardia.
Choose the statements that correctly match the hypertensive medication with its side effect. Select all that apply. With ACE inhibitors, assess for bradycardia. Cough is a common side effect of adrenergic inhibitors. With thiazide diuretics, monitor serum potassium concentration. Direct vasodilators may cause headache and tachycardia. Beta-blockers may cause sedation.
"The difference is the timing of the delivery of the electric current."
During a CPR class, a participant asks about the difference between cardioversion and defibrillation. What would be the instructor's best response? "The difference is the timing of the delivery of the electric current." "Defibrillation is synchronized with the electrical activity of the heart, but cardioversion is not." "Cardioversion is done on a beating heart; defibrillation is not." "Cardioversion is always attempted before defibrillation because it has fewer risks."
Disrupting the heart during the critical period of ventricular repolarization.
Elective cardioversion is similar to defibrillation except that the electrical stimulation waits to discharge until an R wave appears. The nurse knows elective cardioversion prevents what? Disrupting the heart during the critical period of atrial repolarization. Disrupting the heart during the critical period of ventricular repolarization. Disrupting the heart during the critical period of ventricular depolarization. Disrupting the heart during the critical period of atrial depolarization.
Application of a sandbag to the area
Following a percutaneous coronary intervention (PCI), a client is returned to the nursing unit with large peripheral vascular access sheaths in place. The nurse understands that which method to induce hemostasis after sheath is contraindicated? Application of a vascular closure device Application of a mechanical compression device Application of a sandbag to the area Direct manual pressure
2 to 2.5
Heparin therapy is usually considered therapeutic when the activated partial thromboplastin time (aPTT) is how many times higher than a normal value? 1 to 1.5 1.5 to 2 2 to 2.5 2.5 to 3
Reassure the client by informing him or her that the lump will disappear with time.
Inform the client that the lump will be removed by the surgeon. Reassure the client and direct the client to the health care provider. Reassure the client by informing him or her that the lump will disappear with time. Reassure the client by informing him or her that the lump will disappear after a course of drug therapy.
Acute pain
Shortly after being admitted to the coronary care unit with an acute myocardial infarction (MI), a client reports midsternal chest pain radiating down his left arm. The nurse notes that the client is restless and slightly diaphoretic, and measures a temperature of 99.6° F (37.6° C); a heart rate of 102 beats/minute; regular, slightly labored respirations at 26 breaths/minute; and a blood pressure of 150/90 mm Hg. Which nursing diagnosis takes highest priority? Decreased cardiac output Anxiety Acute pain Risk for imbalanced body temperature
pulmonary artery wedge pressure
The balloon on the distal tip of a pulmonary artery catheter is inflated and the pressure is measured. What is the term for the measurement obtained? pulmonary artery wedge pressure cardiac output central venous pressure pulmonary artery pressure
"Arteriosclerosis is a condition that produces structural changes in the arteries, and atherosclerosis is a specific type of arteriosclerosis." "
The client asks the nurse to explain the difference between arteriosclerosis and atherosclerosis. Which is the best explanation provided by the nurse? "Arteriosclerosis is a condition that produces structural changes in the arteries, and atherosclerosis is a specific type of arteriosclerosis." "Arteriosclerosis is when the vessels become dilated and weakened,whereas atherosclerosis is the deposit of fatty substances in the vessel lining." "Atherosclerosis and arteriosclerosis are disorders in which the lining of the vessels become narrowed due to plaque formation." "Arteriosclerosis and atherosclerosis are the same disorder. The terms are interchangeable."
Pulmonary artery pressure monitoring (PAPM
The critical care nurse is caring for a client who has had an MI. The nurse should expect to assist with establishing what hemodynamic monitoring procedure to assess the client's left ventricular function? Systemic arterial pressure monitoring (SAPM) Arterial blood gases (ABGs) Pulmonary artery pressure monitoring (PAPM) Central venous pressure (CVP) monitoring
To assess the client's response to fluid and drug administration
The critical care nurse is caring for a client with a pulmonary artery pressure monitoring system. In addition to assessing left ventricular function, what is an additional function of a pulmonary artery pressure monitoring system? To assess the client's response to fluid and drug administration To diagnose the etiology of chronic obstructive pulmonary disease To obtain specimens for arterial blood gas measurements To dislodge pulmonary emboli
Possible hypovolemia
The health care provider has placed a central venous pressure (CVP) monitoring line in an acutely ill client so right ventricular function and venous blood return can be closely monitored. The results show decreased CVP. What does this indicate? Possible hypovolemia Possible myocardial infarction (MI) Aortic valve regurgitation Left-sided heart failure
During ventricular depolarization
The nurse and student nurse are observing a cardioversion procedure completed by a physician. At which time is the nurse most correct to identify to the student when the electrical current will be initiated? During repolarization of the heart During the QRS complex During stimulation of the SA node During ventricular depolarization
Check pulse daily, reporting sudden slowing or increase Wear a medical alert, noting the presence of a pacemaker Avoid handheld screening devices in airports
The nurse cares for a client following the insertion of a permanent pacemaker. What discharge instruction(s) should the nurse review with the client? Select all that apply. Avoid handheld screening devices in airports Refrain from walking through antitheft devices Check pulse daily, reporting sudden slowing or increase Wear a medical alert, noting the presence of a pacemaker Avoid the usage of microwave ovens and electronic tools
disorientation, 20 mL of urine over the last 2 hours
The nurse cares for a client in the ICU diagnosed with coronary artery disease (CAD). Which assessment data indicates the client is experiencing a decrease in cardiac output? elevated jugular venous distention and postural changes in BP reduced pulse pressure and heart murmur disorientation, 20 mL of urine over the last 2 hours BP 108/60 mm Hg, ascites, and crackles
Request a digoxin level be ordered
The nurse cares for a client who has developed junctional tachycardia with a heart rate (HR) of 80 bpm. Which action should the nurse complete? Prepare to administer IV lidocaine Withhold the client's oral potassium supplement Prepare for emergent electrical cardioversion Request a digoxin level be ordered
Ineffective health maintenance
The nurse caring for a client with a leg ulcer has finished assessing the client and is developing a problem list prior to writing a plan of care. What major nursing diagnosis might the care plan include? Risk for disuse syndrome Imbalanced nutrition: less than body requirements Ineffective health maintenance Sedentary lifestyle
Anxiety Alcohol Hypoxemia Atrial ischemia
The nurse explains to the patient with PACs that there are many causes, some of which are modifiable. Select all that apply. Hyperkalemia Anxiety Alcohol Hypoxemia Hypovolemia Atrial ischemia
Call emergency services if, after taking three tablets (one every 5 minutes), pain persists. Let the tablet dissolve in the mouth and keep the tongue still. Renew the supply every 6 months. Take the tablet in anticipation of any activity that can produce pain.
The nurse has been asked to teach a patient how to self-administer nitroglycerin. The nurse should instruct the patient to do which of the following? Select all of the teaching points that apply. Let the tablet dissolve in the mouth and keep the tongue still. The tablet can be crushed between the teeth but not swallowed. Renew the supply every 6 months. Keep the tablets at home on the kitchen counter or bedside table so they can be reached quickly. Take the tablet in anticipation of any activity that can produce pain. Call emergency services if, after taking three tablets (one every 5 minutes), pain persists. Put some of the tablets in a small metal or plastic pillbox that can be easily carried at all times and be accessible quickly, when needed.
"I can take nitroglycerin before sex so I won't develop chest pain".
The nurse has completed a teaching session on self-administration of sublingual nitroglycerin. Which client statement indicates that the teaching has been effective? "I can take nitroglycerin before sex so I won't develop chest pain". "I can put the nitroglycerin tablets in my daily pill dispenser with my other medications". "Side effects of nitroglycerin include flushing, throbbing headache, and hypertension". "After taking two tablets with no relief, I should call EMS."
Dyspnea, fatigue, and weakness
The nurse is assessing a client with mitral regurgitation. The nurse expects to note what finding in this client? Orthopnea, angina, and pulmonary edema Dry cough, wheezing, and hemoptysis Dizziness, syncope, and palpitations Dyspnea, fatigue, and weakness
Apply a heating pad to the patient's abdomen.
The nurse is assessing a patient two days postoperatively who is suspected of having deep vein obstruction. The patient is complaining of pain in the left lower extremity and there is a 2-cm difference in the right and left leg circumference. What intervention can the nurse provide to promote arterial flow to the lower extremities? Apply cool compresses to the left lower extremity. Administer a diuretic to decrease the edema in the left lower extremity. Assist with active range-of-motion (ROM) exercises to the left lower extremity. Apply a heating pad to the patient's abdomen.
Cool and cyanotic skin Sharp pain that may be relieved by the elevation of the extremity Full superficial veins
The nurse is assessing a patient with suspected acute venous insufficiency. What clinical manifestations would indicate this condition to the nurse? (Select all that apply.) Full superficial veins Initial absence of edema Brisk capillary refill of the toes Cool and cyanotic skin Sharp pain that may be relieved by the elevation of the extremity
Abrupt closure of the artery Arterial dissection Coronary artery vasospasm
The nurse is assessing a postoperative patient who had a percutaneous transluminal coronary angioplasty (PTCA). Which possible complications should the nurse monitor for? (Select all that apply.) Aortic dissection Coronary artery vasospasm Nerve root pressure Abrupt closure of the artery Arterial dissection
Avoid continuous BP monitoring
The nurse is caring for a client diagnosed with unstable angina who is receiving IV heparin. The client requires bleeding precautions. Bleeding precautions include which measure? Use an electric toothbrush Avoid the use of nail clippers Avoid subcutaneous injections Avoid continuous BP monitoring
Elevated blood pressure Obesity
The nurse is caring for a client newly diagnosed with coronary artery disease (CAD). While developing a teaching plan for the client to address modifiable risk factors for CAD, the nurse will include which factor(s)? Select all that apply. Alcohol use Drug use Elevated blood pressure Decreased LDL level Obesity
Heavy exudate
The nurse is caring for a client who is admitted to the medical unit for the treatment of a venous ulcer in the area of her lateral malleolus that has been unresponsive to treatment. What is the nurse most likely to find during an assessment of this client's wound? Deep wound bed Heavy exudate Hemorrhage Pale-colored wound bed
Creatinine kinase-myoglobin (CK-MB) level
The nurse is caring for a client who was admitted to the telemetry unit with a diagnosis of "rule/out acute MI." The client's chest pain began 3 hours earlier. Which laboratory test would be most helpful in confirming the diagnosis of a current MI? Troponin C level Myoglobin level CK-MM Creatinine kinase-myoglobin (CK-MB) level
Intubation and mechanical ventilation
The nurse is caring for a client who will have coronary artery revascularization. When explaining the pre- and postoperative regimens, the nurse should address which subject? Intubation and mechanical ventilation Symptoms of low blood pressure Symptoms of hypovolemia Complications requiring graft removal
Provide a high-calorie, high-protein diet.
The nurse is caring for a client with a large venous leg ulcer. What intervention should the nurse implement to promote healing and prevent infection? Irrigate the wound with hydrogen peroxide once daily. Provide a high-calorie, high-protein diet. Apply a clean occlusive dressing once daily and whenever soiled. Apply an antibiotic ointment on the surrounding skin with each dressing change.
Measure urine output.
The nurse is caring for a client with a valvular disorder. The client is at risk for decreased cardiac output. What nursing intervention should a nurse perform for this client? Perform exercises consistently. Auscultate lung and heart sounds. Keep legs horizontal. Measure urine output.
Eyes
The nurse is caring for a client with accelerated hypertension. Which body system would the nurse assess to identify early signs of blood pressure progression? Kidney Eyes Musculoskeletal system Heart
Right ventricle
The nurse is caring for a client with nursing diagnosis of ineffective tissue perfusion. Which area of the heart would the nurse anticipate being compromised? Aorta Pulmonary artery Right ventricle Right atrium
Maintain firm contact between paddles and the client's skin.
The nurse is caring for an adult client who has gone into ventricular fibrillation. When assisting with defibrillating the client, what must the nurse do? Maintain firm contact between paddles and the client's skin. Ensure the defibrillator is in the sync mode. Call "all clear" once before discharging the defibrillator. Apply a layer of water as a conducting agent.
20 to 25 lbs
The nurse is defibrillating a patient in ventricular fibrillation with paddles on a monophasic defibrillator. How much paddle pressure should the nurse apply when defibrillating? 5 to 10 lbs 20 to 25 lbs 15 to 20 lbs 5 to 10 lbs
Elevate the legs above the heart level for 30 minutes every 2 hours. Sleep with the foot of the bed elevated about 6 inches. Avoid constricting garments.
The nurse is educating a patient with chronic venous insufficiency about prevention of complications related to the disorder. What should the nurse include in the information given to the patient? (Select all that apply.) Elevate the legs above the heart level for 30 minutes every 2 hours. Avoid constricting garments. Sit on the side of the bed and dangle the feet. Sleep with the foot of the bed elevated about 6 inches. Sit as much as possible to rest the valves in the legs.
heart rate 48
The nurse is explaining vasovagal syncope to a client and family.What does the nurse associate the temporary loss of consciousness with for the client? increase fluid intake heart rate 48 vertigo blood pressure 190/50 standing
Hemorrhage, sepsis, and anaphylaxis
The nurse is monitoring a client experiencing a decrease cardiac output. What medical conditions will lead to a decrease in preload? Fluid overload, sepsis, and vasodilation Myocardial infarction, fluid overload, and diuresis Hemorrhage, sepsis, and anaphylaxis Third spacing, heart failure, and diuresis
Congenital heart disease.
The nurse is performing a skin assessment for a client and observes a blue tinge in the buccal mucosa and tongue. What condition does the nurse correlate this finding with? Intermittent arteriolar vasoconstriction. Congenital heart disease. Peripheral vasoconstriction. Blood leaking outside the blood vessels.
Determination of atrial thrombi
The nurse is preparing a client for a transesophageal echocardiography. What will be an indication for the client to have a transesophageal echocardiography? Determination of atrial thrombi Evaluation of myocardial perfusion at rest and after exercise. Determination of electrical activity of the heart. Evaluation of the response of the cardiovascular system to increased oxygen demands.
Decreased response to beta-blockers
The nurse is preparing discharge instructions for an elderly client with cardiovascular health changes. What is an age-related change in the cardiovascular system that the nurse considers that may affect the sympathetic nervous system? Decreased response to beta-blockers Tachycardia Increased contractility response to exercise Decreased time for the heart rate to return to baseline
Unequal peripheral pulses between extremities
The nurse is providing care for a client who has just been diagnosed with peripheral arterial occlusive disease (PAD). What assessment finding is most consistent with this diagnosis? Numbness and tingling in the distal extremities Reddened extremities with muscle atrophy Unequal peripheral pulses between extremities Visible clubbing of the fingers and toes
Creatine kinase MB
The nurse is reviewing the laboratory results for a patient having a suspected myocardial infarction (MI). What cardiac-specific isoenzyme does the nurse observe for myocardial cell damage? Alkaline phosphatase Myoglobin Creatine kinase MB Troponin
Decreased peripheral resistance Decreased blood volume Decreased strength and rate of myocardial contractions
The nurse is reviewing the medication administration record of a client who takes a variety of medications for the treatment of hypertension. What potential therapeutic benefits of antihypertensives should the nurse identify? Select all that apply. Increased venous return Decreased blood volume Decreased strength and rate of myocardial contractions Decreased blood viscosity Decreased peripheral resistance
Acidosis
The nurse is teaching a client about myocardial contractility. What factor may decrease a client's myocardial contractility? Acidosis Sympathetic activity Administration of digoxin Alkalosis
Cerebrovascular disease Transient ischemic attacks (TIAs) Retinal hemorrhage
The nurse is teaching a client about some of the health consequences of uncontrolled hypertension. What health problems should the nurse describe? Select all that apply. Cerebrovascular disease Right ventricular hypertrophy Retinal hemorrhage Venous insufficiency Transient ischemic attacks (TIAs)
A client with anorexia and history of no healthcare insurance
The nurse is working on a busy cardiac unit caring for four hypertensive clients. Which client description would the nurse assess first because the client is at an increased risk for malignant hypertension? A client with liver dysfunction who drinks alcohol daily A schizophrenic residing at an assisted living facility A client with anorexia and history of no healthcare insurance A client with chronic asthma who uses a corticosteroid inhaler
B. A weight gain of 10 lbs
The nurse observes that a patient has 2+ pitting edema in the lower extremities. What does the nurse know that the presence of pitting edema indicates regarding fluid retention? A. A weight gain of 6 lbs B. A weight gain of 10 lbs C. A weight gain of 8 lbs D. A weight gain of 4 lbs
Abrupt closure of the coronary artery Arterial occlusion Bleeding at the insertion sit Retroperitoneal bleeding
The nurse providing care for a client post PTCA knows to monitor the client closely. For what complications should the nurse monitor the client? Select all that apply. Abrupt closure of the coronary artery Retroperitoneal bleeding Arterial occlusion Bleeding at the insertion site Venous insufficiency
Avoid elevating the knees on the bed. Initiate passive exercises. Apply antiembolism stockings.
The nurse understands it is important to promote adequate tissue perfusion following cardiac surgery. Which measures should the nurse complete to prevent the development of deep venous thrombosis (DVT) and possible pulmonary embolism (PE)? Select all that apply. Place pillows in the popliteal space. Avoid elevating the knees on the bed. Initiate passive exercises. Apply antiembolism stockings. Encourage the client to cross their legs.
hypothermia Hypovolemia Hypoxia Acidosis
The nurse understands that asystole can be caused by several conditions. Select all that apply. Acidosis Hypothermia Alkalosis Hypovolemia Hypoxia
Coronary thrombosis
The nursing instructor is talking about myocardial infarctions (MI) to her junior nursing class. What would the instructor tell the students is the most common cause of an MI? Coronary thrombosis Venous stasis Arteriosclerosis Stroke
Cardiac glycosides
The nursing instructor is teaching the junior nursing students about aortic regurgitation. What classification of drugs are used to treat aortic regurgitation? Anticoagulants Antihypertensives Cardiac glycosides Anti-arrhythmics
Bradycardia
The treatment for symptomatic junctional rhythm is the same as for which of the following other heart rhythms? Bradycardia Atrial flutter Atrial fibrillation Tachycardia
Pacing spike occurs at the preset level
Undersensing occurs as a pacemaker malfunctions. The nurse understands undersensing occurs as a result of which event? Pacing spike occurs at the preset level The complex does not follow the pacing spike Total absence of the pacing spike Loss of pacing artifact
Hypertension
Understanding atherosclerosis, the nurse identifies which of the following to be both a risk factor for the development of the disorder and an outcome? Glucose intolerance Hyperlipidemia Hypertension Obesity
T-wave inversion An abnormal Q wave ST-segment elevation
What ECG findings does the nurse observe in a patient who has had a myocardial infarction (MI)? (Select all that apply.) T-wave inversion An abnormal Q wave Prolonged P-R interval An absent P wave ST-segment elevation
Immediate bystander CPR
What is the treatment of choice for ventricular fibrillation? Implanted defibrillator Immediate bystander CPR Atropine Pacemaker
Level of consciousness, characteristics of pain, and signs of hemorrhage or dissection
When caring for a client with a diagnosis of aortic aneurysm scheduled for surgery, what would be most important for the nurse to monitor? Intake and output, nutrition level, respirations, and characteristics of pain Level of consciousness, characteristics of pain, and signs of hemorrhage or dissection BP, pulse, respirations, and signs of hemorrhage or dissection Cultural needs, characteristics of pain, and signs of hemorrhage or dissection
A. A flush system C. A transducer E. A pressure bag
When hemodynamic monitoring is ordered for a client, a catheter is inserted into the appropriate blood vessel or heart chamber. When assessing a client who has such a device in place, the nurse should check which of the following components? Select all that apply. A. A flush system B. A leveler C. A transducer D. An oscillator E. A pressure bag
B. Monitor BP and pulse frequently. C. Palpate the pulse in different locations. D. Inspect pressure dressing for signs of bleeding.
Which assessments should a nurse perform when caring for a client following a cardiac catheterization? Select all that apply. A. Palpate the insertion site for tenderness. B. Monitor BP and pulse frequently. C. Palpate the pulse in different locations. D. Inspect pressure dressing for signs of bleeding. E. Inspect the color in every extremity.
a client with a chronic, nonhealing skin lesion
Which client with a venous stasis ulcer is a candidate for topical hyperbaric oxygen therapy? a client whose ulcer includes necrotic tissue a client with an infected stasis ulcer a client with a chronic, nonhealing skin lesion a nonambulatory client
Electrophysiology study
Which diagnostic study best evaluates different medications ability to restore normal heart rhythm? Electrocardiogram (ECG) Elective electrical cardioversion Echocardiogram Electrophysiology study
sinus bradycardia
Which dysrhythmia is common in older clients? Sinus tachycardia Ventricular tachycardia Sinus bradycardia Atrial fibrillation
Atropine
Which medication should a nurse have on hand when removing a sheath after cardiac catheterization? Heparin Adenosine (Adenocard) Protamine sulfate Atropine
Self-Care Deficit
Which nursing diagnosis is most significant in planning the care for a client with Raynaud's disease? Activity Intolerance Self-Care Deficit Acute Pain Disturbed Sensory Perception
Hematoma Embolization Bleeding Stent migration Dissection of the vessel
Which of the following are complications of percutaneous transluminal balloon angioplasty (PTA)? Select all that apply. Hematoma Embolization Bleeding Stent migration Dissection of the vessel
infection
Which of the following is a physiological stressor associated with atrial fibrillation? Parasympathomimetic drugs Hypocarbia Hyperglycemia Infection
Initiates the parasympathetic response
Which of the following is a true statement regarding the role of baroreceptors? Initiates the sympathetic response Initiates the parasympathetic response Increases blood pressure Increases in heart rate
Diazepam
Which of the following medications does the nurse anticipate administering to a client preparing for cardioversion? Enalapril Diazepam Digoxin Atropine
Ineffective Tissue Perfusion
Which of the following nursing diagnosis is the nurse most correct to choose when caring for a client with long-standing hypertension? Ineffective Tissue Perfusion Activity Intolerance Impaired Gas Exchange Risk for Decreased Cardiac Output
automaticity
Which term describes the ability of the heart to initiate an electrical impulse? automaticity conductivity excitability contractility
transthoracic echocardiography
Which test used to diagnose heart disease is least invasive? coronary arteriography cardiac catheterization magnetic resonance imaging transthoracic echocardiography
A. A 20-year-old client
While auscultating a client's heart sounds, the nurse hears an extra heart sound immediately after the second heart sound (S2). An audible S3 would be considered an expected finding in what client? A. A 20-year-old client B. A client who has undergone valve replacement C. An older adult D. A client who takes a beta-adrenergic blocker
Notify the health care provider.
While receiving a heparin infusion to treat deep vein thrombosis, a client reports bleeding in the gums when brushing teeth. What should the nurse do first? Stop the heparin infusion immediately. Administer a coumarin derivative, as ordered, to counteract heparin. Reassure the client that bleeding gums are a normal effect of heparin. Notify the health care provider.
During and a few hours after exercise electrocardiography.
You are caring for a client who is suspected of having coronary artery disease. The client is scheduled to have a nuclear stress test using thallium. When would the thallium be injected to determine narrowing of the coronary arteries? During and a few hours after exercise electrocardiography. Before and during exercise electrocardiography. Before and a few hours after exercise electrocardiography. Before, during, and a few hours after exercise electrocardiography.
Lupus-like syndrome
Your client has just been prescribed Pronestyl for their dysrhythmia. What would you teach this client about the side effects? Decreased appetite Hypertension Change in mental status Lupus-like syndrome
multiple gated acquisition scan (MUGA)
the physician is ordering a test for the hypertensive client that will be able to evaluate whether the client has experienced heart damage. Which diagnostic test would the nurse anticipate to determine heart damage? fluorescein angiography blood chemistry multiple gated acquisition scan (MUGA) Chest radiograph
