NUR 1172 PrepU Chapters 26-28 and 30

Heart block

Identify which of the following as an age-related change associated with conduction system of the heart?

High LDL Levels

Jack Donohue, a 62-year-old stock broker, attends his annual physical appointment and indicates physical changes since his last examination. He reports chest pain and palpitation during and after his morning jogs. Jack's family history reveals includes coronary artery disease. His lipid profile reveals his LDL level to be 122 mg/dl. Which of the following correctly states the Jack's condition?

Atrial depolarization

The nurse caring for a patient with a dysrhythmia understands that the P wave on an electrocardiogram (ECG) represents what phase of the cardiac cycle?

Dyspnea, fatigue, and weakness

The nurse is assessing a client with mitral regurgitation. The nurse expects to note which of the following findings in this client?

Troponin T and I

The nurse is awaiting results of cardiac biomarkers for a patient with severe chest pain. The nurse would identify which cardiac biomarker as remaining elevated the longest when myocardial damage has occurred?

"We will be getting rid of our microwave oven so it will not affect my pacemaker."

The nurse is caring for a client who had a permanent pacemaker surgically placed yesterday and is now ready for discharge. Which statement made by the client indicates the need for more education.

"You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks."

The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. The client, an avid tennis player, is scheduled to play in a tournament in 1 week. What is the best advice the nurse can give related to this activity?

Decreased cardiac output

The nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor. The client is symptomatic due to the slow heart rate. The most appropriate nursing diagnosis for this client would be which of the following?

Avoid tub baths, but shower as desired.

The nurse is providing discharge education for the client going home after a cardiac catheterization. Which of the following would be important information to give this client?

Your family and friends may want to take a CPR class.

The nurse is proving discharge instruction for a patient with a new arrhythmia. Which of the following should the nurse include?

Chest pain, weight gain, fatigue.

The nurse is taking a health history from a client admitted with the medical diagnosis of cardiovascular disease (CVD). Identify which of the following symptoms indicate CVD.

Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers

The nurse is teaching a beginning EKG class to staff nurses. As the nurse begins to discuss the the parts of the EKG complex, one of the students asks what the normal order of conduction through the heart is. The correct response would be which of the following?

Give an IV bolus of atropine.

The nurse is working on a telemetry unit, caring for a client who has been in a sinus rhythm for the past 2 days with a heart rate of 88 to 96 beats per minute. The client puts on the call light in the bathroom and reports severe dizziness. The telemetry shows a heart rate of 46 beats per minute. What should the nurse be prepared to do?

Gradual, unexplained weight gain.

A 63-year-old accountant was admitted to the cardiac ICU with full-blown pulmonary edema. After he was revived, the nurse discusses his symptoms with the client and his wife. What is a typical, subtle symptom that communicates right-sided heart failure?

"Client walks 4 miles in 1 hour every day."

A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the ordered cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction?

anticoagulant.

A client has a blockage in the proximal portion of a coronary artery. After learning about treatment options, the client decides to undergo percutaneous transluminal coronary angioplasty (PTCA). During this procedure, the nurse expects to administer an:

IV bolus of atropine or temporary pacing

A client has a medical diagnosis of an advanced AV block and is symptomatic due to a slow heart rate. With what initial treatment(s) should the nurse be prepared to assist?

• Carry a card identifying yourself as a pacemaker recipient. • Avoid large magnetic fields.

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.

Weighing the client daily at the same time each day.

A client is at risk for excess fluid volume. Which nursing intervention ensures the most accurate monitoring of the client's fluid status?

Pulmonary Congestion

A client is being assessed for his semiannual examination and you hear crackles bilaterally in his lungs. Which of the following could be a cause of crackles in the bases of his lungs?

Bibasilar crackles

A client is returning from the operating room after inguinal hernia repair. The nurse notes that he has fluid volume excess from the operation and is at risk for left-sided heart failure. Which sign or symptom indicates left-sided heart failure?

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?

"My chest pain is decreasing."

A client with an acute myocardial infarction is receiving nitroglycerin by continuous I.V. infusion. Which client statement indicates that this drug is producing its therapeutic effect?

"You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site."

A home care nurse is visiting a left-handed client who has an implantable cardioverter-defibrillator (ICD) implanted in his left chest. The client tells the nurse how excited he is because he's planning to go rifle hunting with his grandson. How should the nurse respond?

10 Minutes

A nurse has come upon an unresponsive, pulseless victim. She has placed a 911 call and begins CPR. The nurse understands that if the patient has not been defibrillated within which time frame, the chance of survival is close to zero?

she'll ask the dietitian to talk with him about modifying his diet.

A nurse is caring for a client who had a three-vessel coronary bypass graft 4 days earlier. His cholesterol profile is as follows: total cholesterol 265 mg/dl, low-density lipoprotein (LDL) 139 mg/dl, and high-density lipoprotein (HDL) 32 mg/dl. The client asks the nurse how to lower his cholesterol. The nurse should tell the client that:

Atropine

A nurse is caring for a client who's experiencing sinus bradycardia with a pulse rate of 40 beats/minute. His blood pressure is 80/50 mm Hg and he complains of dizziness. Which medication does the nurse anticpate administering to treat his bradycardia?

Place the client in high Fowler's position.

A nurse is caring for a client with acute pulmonary edema. To immediately promote oxygenation and relieve dyspnea, the nurse should:

The client demonstrates ability to tolerate more activity without chest pain.

A nurse is evaluating a client who had a myocardial infarction (MI) 7 days earlier. Which outcome indicates that the client is responding favorably to therapy?

"I'll keep a log of each time my ICD discharges."

A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching?

"The only difference is the rate, which will be below 60 bpm in sinus bradycardia."

A nursing student is caring for one of the nurse's assigned cardiac clients. The student asks, "How can I tell the difference between sinus rhythm and sinus bradycardia when I look at the EKG strip" The best reply by the nurse is which of the following?

"Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast with wide QRS complexes."

A nursing student is caring for one of the nurse's assigned cardiac clients. The student asks, "How can I tell the difference between ventricular tachycardia and ventricular fibrillation when I look at the EKG strip?" The best reply by the nurse is which of the following?

Decrease myocardial contractility.

A patient has a high magnesium level. Identify how hypermagnesemia affects cardiac function.

Low blood pressure

A patient is receiving anticoagulant therapy. The nurse should be alert to potential signs and symptoms of external or internal bleeding, as evidenced by which of the following?

Sodium

Admission lab values on a patient admitted with congestive heart failure are as follows: potassium 3.4 mEq/L; sodium 148 mEq/L; calcium 9.8 mg/dL; and magnesium 1.5 mEq/L. Which lab value is abnormal?

Decreased cardiac output and decreased systolic and diastolic blood pressure

After evaluating a client for hypertension, a physician orders atenolol (Tenormin), 50 mg P.O. daily. Which therapeutic effect should atenolol have?

Avoid undergoing magnetic resonance imaging (MRI).

After having several Stokes-Adams attacks within 4 months, a client reluctantly agrees to implantation of a permanent pacemaker. Before discharge, the nurse reviews pacemaker care and safety guidelines with the client and his spouse. Which safety precaution is appropriate for a client who has a pacemaker?

a history of diabetes mellitus.

An obese white male client, age 49, is diagnosed with hypercholesterolemia. The physician orders a low-fat, low-cholesterol, low-calorie diet to reduce blood lipid levels and promote weight loss. This diet is crucial to the client's well-being because his race, sex, and age increase his risk for coronary artery disease (CAD). To determine whether the client has other major risk factors for CAD, the nurse should assess for:

The defibrillator won't deliver a shock if the synchronizer switch is turned on.

Before using a defibrillator to terminate ventricular fibrillation, a nurse should check the synchronizer switch. Why is this check so important?

Sawtooth

The staff educator is presenting a class on cardiac dysrhythmias. How would the educator describe the characteristic pattern of the atrial waves in atrial flutter?

It is used to eliminate ventricular dysrhythmias.

The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation?

P wave

To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform?

Pacemaker site infection

Two days after discharge following a permanent pacemaker insertion, the client returns to the clinic for a follow-up appointment. He reports tenderness and throbbing around the incision. The nurse observes mild swelling, erythema, and warmth at the site and suspects which of the following:

Premature ventricular contraction

When the nurse observes an ECG tracing on a cardiac monitor with a pattern in lead II and observes a bizarre, abnormal shape to the QRS complex, the nurse has likely observed which of the following ventricular dysrhythmias?

Unstable

When the patient diagnosed with angina pectoris complains that he is experiencing chest pain more frequently even at rest, the period of pain is longer, and it takes less stress for the pain to occur, the nurse recognizes that the patient is describing which type of angina?

Hyperkalemia

When the postcardiac surgery patient demonstrates restlessness, nausea, weakness, and peaked T waves, the nurse reviews the patient's serum electrolytes anticipating which abnormality?

Coumadin

Which medication is indicated for the patient with atrial fibrillation who is at high risk for stroke?

Atropine

Which medication is the drug of choice for sinus bradycardia?

Pulmonary artery

Which of the follow arteries carries deoxygenated blood?

Hyperlipidemia

Which of the following is a modifiable risk factor for coronary artery disease (CAD)?

Instruct the patient to restrict food and oral intake.

Which of the following nursing interventions is required to prepare a patient with cardiac dysrhythmia for an elective electrical cardioversion?

Avoid sources of electrical interference.

Which of the following postimplantation instructions must a nurse provide a patient with a permanent pacemaker?

PR interval

Which of the following tends to be prolonged on the electrocardiogram (ECG) during a first-degree atrioventricular (AV) block?

Inability to speak.

Which of the following would be inconsistent as criterion of extubation in the patient who has undergone a coronary artery bypass graft (CABG)?

Hypovolemia and fever

While assessing a client, the nurse finds a heart rate of 120 beats per minute. The nurse recalls that causes of sinus tachycardia include which of the following?

Atrial rate of 300 to 400

Electrocardiogram (ECG) characteristics of atrial fibrillation include which of the following?

Right Ventricle

Within the physiology of the heart, each chamber has a particular role in maintaining cellular oxygenation. Which chamber of the heart is responsible for pumping blood to the lungs to be oxygenated?

Left atrium

Within the physiology of the heart, each chamber has a particular role in maintaining cellular oxygenation. Which chamber of the heart is responsible for receiving oxygenated blood from the lungs?

Clients with recurrent life-threatening tachydysrhythmias.

You are caring for a client who has been admitted to have a cardioverter defibrillator implanted. You would know that implanted cardioverter defibrillators are used in what clients?

Immediate defibrillation

You enter your client's room and find them pulseless and unresponsive. What would be the treatment of choice for this client?

Elective electrical cardioversion

Your client has been diagnosed with an atrial dysrhythmia. The client has come to the clinic for a follow-up appointment and to talk with the physician about options to stop this dysrhythmia. What would be a procedure used to treat this client?

Thallium-201

Your client is going to have a stress test. What radionuclide would most likely be used to diagnose ischemic heart disease during this test?

Treating the underlying cause

Your patient is experiencing asymptomatic sinus tachycardia with a rate of 118. The nurse understands that the treatment of this condition includes: