NUR 295 Exam 4 Perfusion

Procedural steps for transfusing a unit of packed red blood cells (PRBCs).

1. Start an intravenous line. 2. Obtain the unit of PRBCs from the blood bank. 3. Double check the labels with another nurse to ensure correct ABO group and Rh type. 4. Initiate the blood transfusion within 30 minutes of receipt. 5. Monitor closely for signs of a transfusion reaction.

PT value

11-13

Normal Hemoglobin (Women)

12 to 16 g/dL or 36% to 48%

Hgb Women

12-16

Normal Hemoglobin (Men)

14 to 17.4 g/dL or 42% to 52%

Hgb Men

14-17

Platelet Count

150,000-400,000

Normal Platelets

150k-400k per cubic mm of blood

PT on anticoagulants

2-2.5 times normal value of 11-13

INR normal value

2-3 (High = BLEED Low = CLOT)

PTT

21-35 seconds

Hct Women

36%-48%

RBC Counts Women

4-5

Normal CO:

4-6

RBC Counts Men

4.5-5.5

Hct Men

42%-52%

Normal Hgb

5-11 g/dL

Normal Troponin

<0.03

D-Dimer Value:

<0.5 (Clots)

The nurse, along with a nursing student, is caring for a client who is admitted with a fractured pacemaker lead related to Twiddler syndrome. The student asks for information about Twiddler syndrome. The appropriate response by the nurse is which of the following? A. "The client twiddles with or manipulates the generator or wires, causing the lead to fracture." B. "A Dr. Twiddler discovered that too much arm movement will cause the lead to fracture." C. "It has to do with a defective lead wire produced by a company named Twiddler." D. "The lead wire breaks and causes symptoms related to lack of pacing; the name has nothing to do with the cause."

A. "The client twiddles with or manipulates the generator or wires, causing the lead to fracture." Twiddler syndrome may occur when the client manipulates the generator, causing lead dislodgement or fracture of the lead.

A client presents to the emergency department reporting chest pain. Which order should the nurse complete first? A. 12-lead ECG B. 2 L oxygen via nasal cannula C. Troponin level D. Aspirin 325 mg orally

A. 12-lead ECG The nurse should complete the 12-lead ECG first. The priority is to determine whether the client is suffering an acute MI and implement appropriate interventions as quickly as possible. The other orders should be completed after the ECG.

The nurse is caring for a client with heart failure. What are the management goals for the client with heart failure? Select all that apply. A. Promoting a healthy lifestyle B. Increasing cardiac output by strengthening muscle contractions C. Reducing the amount of circulating blood volume D. Lowering the risk for hospitalization E. Increasing preload and afterload

A. Promoting a healthy lifestyle B. Increasing cardiac output by strengthening muscle contractions D. Lowering the risk for hospitalization The management of a client with heart failure includes promotion of a healthy lifestyle, increasing cardiac output by strengthening muscle contractions, and lowering the risk for hospitalization. There is no need to reduce circulating blood volume for clients with heart failure. The goal in treating heart failure is to decrease preload and afterload, both of which increase stress on the ventricular wall, causing an increase in the workload of the heart.

A client asks the nurse about complications associated with use of a cardiac pacemaker. What does the nurse include in their response? Select all that apply. A. Twiddler syndrome B. Hiccupping C. Positive Kernig's sign D. Localized infection E. Negative Babinski reflex

A. Twiddler syndrome B. Hiccupping D. Localized infection Complications associated with pacemakers include infection at entry site, pneumothorax, bleeding and hematoma, hemothorax, ventricular ectopy and tachycardia, phrenic nerve/diaphragmatic(hiccupping)/skeletal stimulation, cardiac perforation, Twiddler syndrome, and hemodynamic instability. A positive Kernig's sign is an indication of meningitis. A positive Babinski reflex is normal in neonates, but indicates a central nervous system disorder in adults.

Resistance the heart must overcome to circulate blood

Afterload

Maintains blood pressure by constricting and dilating in response to stimuli

Arteries

During a CPR class, a participant asks about the difference between cardioversion and defibrillation. What would be the instructor's best response? A. "Cardioversion is done on a beating heart; defibrillation is not." B. "The difference is the timing of the delivery of the electric current." C. "Defibrillation is synchronized with the electrical activity of the heart, but cardioversion is not." D. "Cardioversion is always attempted before defibrillation because it has fewer risks."

B. "The difference is the timing of the delivery of the electric current." One major difference between cardioversion and defibrillation is the timing of the delivery of electrical current. In cardioversion, the delivery of the electrical current is synchronized with the client's electrical events; in defibrillation, the delivery of the current is immediate and unsynchronized. Both can be done on beating heart (i.e., in a dysrhythmia). Cardioversion is not necessarily attempted first.

The nurse is caring for a client who has a history of heart disease. What factor should the nurse identify as possibly contributing to a decrease in cardiac output? A. A change in position from standing to sitting B. A heart rate of 54 bpm C. A pulse oximetry reading of 94% D. An increase in preload related to ambulation

B. A heart rate of 54 bpm Cardiac output is computed by multiplying the stroke volume by the heart rate. Cardiac output can be affected by changes in either stroke volume or heart rate, such as a rate of 54 bpm. An increase in preload will lead to an increase in stroke volume. A pulse oximetry reading of 94% does not indicate hypoxemia, as hypoxia can decrease contractility. Transitioning from standing to sitting would more likely increase rather than decrease cardiac output.

A nursing instructor is reviewing the parts of an EKG strip with a group of students. One student asks about the names of all the EKG cardiac complex parts. Which of the following items are considered a part of the cardiac complex on an EKG strip? Choose all that apply. A. QRT wave B. P wave C. S-Q segment D. P-R interval E. T wave

B. P wave D. P-R interval E. T wave The EKG cardiac complex waves include the P wave, the QRS complex, the T wave, and possibly the U wave. The intervals and segments include the PR interval, the ST segment, and the QT interval.

What is it? - Heart can't pump - can arise from severe MI, life-threatening arrhythmias, endocarditis, tamponade, or drug overdose

Cardiogenic Shock

generated by cardiac output/The amount of blood pumped by the heart each minute

Central Perfusion is

Three Stages of Shock

Compensatory, Progressive, Irreversible

produces a pressure which pushes blood from the arteries through the capillaries to interstitial spaces

Contraction of the ventricles

An intensive care nurse is aware of the need to identify clients who may be at risk of developing disseminated intravascular coagulation (DIC). Which ICU client most likely faces the highest risk of DIC? A. A client with extensive burns B. A client who has a diagnosis of acute respiratory distress syndrome C. A client who suffered multiple trauma in a workplace accident D. A client who is being treated for septic shock

D. A client who is being treated for septic shock Sepsis is a common cause of DIC. A wide variety of acute illnesses can precipitate DIC, but sepsis is specifically identified as a cause.

A negative chronotropic effect will ________

Decrease Heart Rate

A negative dromotropic effect will _________

Decrease conduction

A negative inotropic effect will __________

Decrease contractility

The circulation of blood through arteries and capillaries delivering nutrients and oxygen to cells and removing cellular waste.

Definition of Perfusion

Shock than can occur through entire SNS, i.e. Anaphylactic, Neurogenic, Septic

Distributive Shock

Repolarization

Electrical Relaxation

Depolarization

Electrical Stimulation

What is it? - Excessive blood loss - Caused by trauma, sports injuries, gunshot wounds - Meds that affect ANS - problems w/Spinal Anesthesia

Hemorrhagic Shock

A positive chronotropic effect will ___________

Increase Heart Rate

A positive dromotropic effect will ____________

Increase conduction

A Positive inotropic effect will __________

Increase contractility

PTT while on heparin (what is happening with the blood?)

Lower the number quicker the clotting time. Higher the number means higher risk of bleeding.

Cardiogenic shock can occur from

MI, life threatening arrhythmias, myocarditis, endocarditis, pericardial tamponade, or drug overdose.

Diastole

Mechanical Relaxation

4 to 6 L/min in the healthy adult at rest

Normal Cardiac Output

The amount of blood in the ventricles at the end of diastole (When the heart is relaxed and filling with blood)

Preload

Consequences of disturbances of Central Perfusion

SHOCK

the amount of blood ejected during ventricular contraction and is dependent on: preload, afterload, and contractility

Stroke Volume

Cardiac Output (CO) (Formula)

Stroke Volume (SV) x Heart Rate (HR) =

When Anaphylactic, Neurogenic and Septic Shock occur

Systemic vasodilation occurs

refers to the volume of blood that flows through target tissues

Tissue Perfusion is

QRS Complex

Ventricular depolarization, normally less than 0.12 seconds in duration.

T wave:

Ventricular repolarization

Hemorrhagic Shock is when

fluid is lost from excessive blood loss

Shock is the

inability of central perfusion to supply blood to peripheral tissues.

Decreased heart rate means

increased preload due to more time

If left untreated, impaired perfusion leads to

ischemia, cell injury, and cell death

Veins are

less sturdy and flexible, allowing them to act as reservoir for extra blood.

Systole

mechanical contraction

Increased heart rate means

not enough time in preload

Valvular disease can effect

preload

P wave:

represents the electrical impulse starting in the SA node and traveling through the atria, atrial depolarization.

Neurogenic Shock can occur from

spinal cord injuries, medications that affect the autonomic nervous system, or problems with spinal anesthesia.

Tissue perfusion is

the amount of blood that flows to target tissues

Cardiogenic Shock is when

the heart is unable to act as pump

Arteries are

tough and flexible, allowing them to withstand the pressure sustained from CO

A client who is a candidate for an implantable cardioverter defibrillator (ICD) asks the nurse about the purpose of this device. What would be the nurse's best response? A. "To detect and treat dysrhythmias such as ventricular fibrillation and ventricular tachycardia." B. "To detect and treat bradycardia, which is an excessively slow heart rate." C. "To detect and treat atrial fibrillation, in which your heart beats too quickly and inefficiently." D. "To shock your heart if you have a heart attack at home."

A. "To detect and treat dysrhythmias such as ventricular fibrillation and ventricular tachycardia." The ICD is a device that detects and terminates life-threatening episodes of ventricular tachycardia and ventricular fibrillation. It does not treat atrial fibrillation, MI, or bradycardia.

A patient with sickle cell disease is brought to the emergency department by a parent. The patient has a fever of 101.6°F, heart rate of 116, and a respiratory rate of 32. The nurse auscultates bilateral wheezes in both lung fields. What does the nurse suspect this patient is experiencing? A. Pneumocystis pneumonia B. Acute chest syndrome C. An exacerbation of asthma D. Pulmonary edema

B. Acute chest syndrome Acute chest syndrome is manifested by fever, respiratory distress (tachypnea, cough, wheezing), and new infiltrates seen on the chest x-ray. These signs often mimic infection, which is often the cause. However, the infectious etiology appears to be atypical bacteria such as Chlamydia pneumoniae and Mycoplasma pneumoniae as well as viruses such as respiratory syncytial virus and parvovirus. Other causes include pulmonary fat embolism, pulmonary infarction, and pulmonary thromboembolism. Seventy-five percent of patients who develop acute chest syndrome had a painful vaso-occlusive crisis, usually lasting an average of 2.5 days prior to developing symptoms of acute chest syndrome (Laurie, 2010).

When giving warfarin you should always check?

Baseline INR and PT

A patient with sickle cell disease comes to the emergency department and reports severe pain in the back, right hip, and right arm. What intervention is important for the nurse to provide? A. Administer aspirin B. Administer ibuprofen C. Start an intravenous line with dextrose 5% in 0.25 normal saline D. Begin oxygen at 2 L/M

C. Start an intravenous line with dextrose 5% in 0.25 normal saline Adequate hydration is important during a painful sickling episode. Oral hydration is acceptable if the patient can maintain adequate fluid intake; IV hydration with dextrose 5% in water (D5W) or dextrose 5% in 0.25 normal saline solution (3 L/m2/24 h) may be required for a sickle crisis. Supplemental oxygen may also be needed.

Which patient does the nurse recognize as being most likely to be affected by sickle cell disease? A. A 14-year-old African American boy B. A 28-year-old Israeli man C. A 26-year-old Eastern European Jewish woman D. An 18-year-old Chinese woman

A. A 14-year-old African American boy The HbS gene is inherited in people of African descent and to a lesser extent in people from the Middle East, the Mediterranean area, and aboriginal tribes in India. Sickle cell anemia is the most severe form of sickle cell disease.

The nurse is teaching a beginning EKG class to staff nurses. As the nurse begins to discuss the parts of the EKG complex, one of the students asks what the normal order of conduction through the heart is. What order does the nurse describe? A. Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers B. AV node, SA node, bundle of His, right and left bundle branches, and the Purkinje fibers C. SA node, AV node, right and left bundle branches, bundle of His, and the Purkinje fibers D. SA node, AV node, bundle of His, the Purkinje fibers, and the right and left bundle branches

A. Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers The correct sequence of conduction through the normal heart is the SA node, AV node, bundle of His, right and left bundle branches, and Purkinje fibers.

A client with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What medical treatment does the nurse anticipate the client will have to terminate the episode of ventricular fibrillation? A. internal cardioverter defibrillator insertion B. pacemaker insertion C. radiofrequency ablation D. electrophysiological study

A. internal cardioverter defibrillator insertion The implantable cardioverter defibrillator (ICD) is an electronic device that detects and terminates life-threatening episodes of tachycardia or fibrillation, especially those that are ventricular in origin. Patients at high risk of ventricular tachycardia (VT) or ventricular fibrillation who would benefit from an ICD are those who have survived sudden cardiac death syndrome, which usually is caused by ventricular fibrillation, or who have experienced spontaneous, symptomatic VT (syncope secondary to VT) not due to a reversible cause (called a secondary prevention intervention). Radiofrequency ablation destroys a small area of heart tissue that is causing rapid and irregular heartbeats, and is used to reduce pain. A cardiac electrophysiology study is an invasive procedure that tests the electrical conduction system of the heart to assess the electrical activity and conduction pathways of the heart.

A client receiving a unit of packed red blood cells develops hives and generalized itching. Which actions will the nurse take to help this client? Select all that apply. A. Apply oxygen via a face mask B. Stop the transfusion C. Administer diphenhydramine as prescribed D. Notify the primary healthcare provider E. Slow the rate of the transfusion

B. Stop the transfusion C. Administer diphenhydramine as prescribed D. Notify the primary health care provider Some clients develop urticaria (hives) or generalized itching during a transfusion; the cause is thought to be a sensitivity reaction to a plasma protein within the blood component being transfused. Symptoms of an allergic reaction are urticaria, itching, and flushing. The reactions are usually mild and respond to antihistamines. The nurse should stop the transfusion and notify the primary health care provider of the client's symptoms. If the symptoms subside, the transfusion can be resumed. The client does not need oxygen. Slowing the rate of the transfusion would not help reduce the symptoms.

The nurse is beginning discharge teaching with a client diagnosed with a myocardial infarction (MI). The nurse will include teaching on what medications? Select all that apply. A. morphine B. atorvastatin C. enalapril D. aspirin E. sildenafil

B. atorvastatin C. enalapril D. aspirin Upon client discharge, there needs to be documentation that the client was discharged on a statin (atorvastatin), an ACE or angiotensin receptor blocking agent (enalapril), and aspirin. Morphine is used to reduce the client's pain and anxiety. Sildenafil is a medication used for pulmonary hypertension.

Which diagnostic study best evaluates different medications ability to restore normal heart rhythm? A. Elective electrical cardioversion B. Electrocardiogram (ECG) C. Electrophysiology study D. Echocardiogram

C. Electrophysiology study An electrophysiology study is a procedure that enables the physician to examine the electrical activity of the heart, produce actual dysrhythmias, and determine the best method for care. Cardioversion uses synchronized electricity to change the rhythm pattern. Electrocardiogram and echocardiograms provide diagnostic information.

A cardiac client's resistance to left ventricular filling has caused blood to back up into the client's circulatory system. Which health problem is likely to result? A. Acute pulmonary edema B. Right-sided heart failure C. Right ventricular hypertrophy D. Left-sided heart failure

A. Acute pulmonary edema With increased resistance to left ventricular filling, blood backs up into the pulmonary circulation. The client quickly develops pulmonary edema from the blood volume overload in the lungs. When the blood backs up into the pulmonary circulation, right-sided heart failure, left-sided heart failure, and right ventricular hypertrophy do not directly occur.

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? A. Administer moderate sedation IV and analgesic medication as prescribed. B. Administer the prescribed digitalis to the client before the scheduled procedure. C. Administer anticoagulant therapy as prescribed prior to the procedure. D. Maintain the client on NPO status for 8 hours prior to the procedure.

A. Administer moderate sedation IV and analgesic medication as prescribed. Before an elective cardioversion, the client should receive moderate sedation IV as well as an analgesic medication or anesthesia. In contrast, in emergent situations, the client may not be premedicated. Digoxin is usually withheld for 48 hours before cardioversion to ensure the resumption of sinus rhythm with normal conduction. If the cardioversion is elective and the dysrhythmia has lasted longer than 48 hours, anticoagulation performed for a few weeks before cardioversion may be indicated. The client is instructed not to eat or drink for at least 4 hours before the procedure.

A nurse working with clients diagnosed with sickle cell disease notices that sickle cell crisis cases increase in the winter months. What is the primary pathophysiological reason for this? A. Colder temperatures slows the blood flow. B. Colder temperatures worsens sickling. C. Colder temperatures increases vessel pressures. D. Colder temperatures impairs oxygen uptake.

A. Colder temperatures slows the blood flow. Colder temperatures lead to vasoconstriction, which slows the blood flow. Colder temperatures do not worsen sickling or impair oxygen uptake. Vasoconstriction does increase vessel pressures but the vessel pressures are not the reason that sickle cell crisis increases with colder temperatures.

The nurse and the other members of the team are caring for a client who converted to ventricular fibrillation (VF). The client was defibrillated unsuccessfully and the client remains in VF. The nurse should anticipate the administration of what medication? A. Epinephrine 1 mg IV push B. Lidocaine 100 mg IV push C. Amiodarone 300 mg IV push D. Sodium bicarbonate 1 amp IV push

A. Epinephrine 1 mg IV push Epinephrine should be given as soon as possible after the first unsuccessful defibrillation and then every 3 to 5 minutes. Antiarrhythmic medications such as amiodarone and lidocaine are given if ventricular dysrhythmia persists.

A patient receiving plasma develops transfusion-related acute lung injury (TRALI) 4 hours after the transfusion. What type of aggressive therapy does the nurse anticipate the patient will receive to prevent death from the injury? (Select all that apply.) A. Fluid support B. Intra-aortic balloon pump C. Intubation and mechanical ventilation D. Oxygen E. Serial chest x-rays

A. Fluid support C. Intubation and mechanical ventilation D. Oxygen Transfusion-related acute lung injury (TRALI) is a potentially fatal, idiosyncratic reaction that is defined as the development of acute lung injury occurring within 6 hours after a blood transfusion. Aggressive supportive therapy (e.g., oxygen, intubation, fluid support) may prevent death.

The nurse is planning the care of a client with heart failure. The nurse should identify what overall goals of this client's care? Select all that apply. A. Improve functional status B. Prevent endocarditis. C. Extend survival. D. Limit physical activity. E. Relieve client symptoms.

A. Improve functional status C. Extend survival. E. Relieve client symptoms. The overall goals of management of heart failure are to relieve the patient's symptoms, to improve functional status and quality of life, and to extend survival. Activity limitations should be accommodated, but reducing activity is not a goal. Endocarditis is not a common complication of heart failure and preventing it is not a major goal of care.

Two days after undergoing a total abdominal hysterectomy, a client complains of left calf pain. Venography reveals deep vein thrombosis (DVT). When assessing this client, the nurse is likely to detect: A. left calf circumference 1" (2.5 cm) larger than the right. B. a decrease in the left pedal pulse. C. pallor and coolness of the left foot. D. loss of hair on the lower portion of the left leg.

A. left calf circumference 1" (2.5 cm) larger than the right. Signs of DVT include inflammation and edema in the affected extremity, causing its circumference to exceed that of the opposite extremity. Pallor, coolness, decreased pulse, and hair loss in an extremity signal interrupted arterial blood flow, which doesn't occur in DVT.

The nurse is admitting a 32-year-old woman to the presurgical unit. The nurse learns during the admission assessment that the client takes oral contraceptives. The nurse's postoperative plan of care should include what intervention? A. Dependent positioning of the client's extremities when at rest B. Early ambulation and leg exercises C. Doppler ultrasound of peripheral circulation twice daily D. Cessation of the oral contraceptives until 3 weeks postoperative

B. Early ambulation and leg exercises Oral contraceptive use increases blood coagulability; with bed rest, the client may be at increased risk of developing deep vein thrombosis. Leg exercises and early ambulation are among the interventions that address this risk. Assessment of peripheral circulation is important, but Doppler ultrasound may not be necessary to obtain these data. Dependent positioning increases the risk of venous thromboembolism (VTE). Contraceptives are not normally discontinued to address the risk of VTE in the short term.

A pregnant client who developed deep vein thrombosis (DVT) in her right leg is receiving heparin I.V. on the medical floor. Physical therapy is ordered to maintain her mobility and prevent additional DVT. A nursing assistant working on the medical unit helps the client with bathing, range-of-motion exercises, and personal care. Which collaborative multidisciplinary considerations should the care plan address? A. The client is at risk for heparin-induced thrombocytopenia; therefore, the care plan should include sequential compression device application and strict bed rest. B. The client is at risk for heparin-induced thrombocytopenia; therefore, the care plan should include reporting evidence of bleeding or easy bruising. C. The client is at risk for developing another DVT; therefore, the care plan should include reporting redness, tenderness, or edema in the other lower extremity. D. The client is pregnant and receiving I.V. heparin, placing her at risk for premature labor; therefore, the care plan should include reporting signs of premature labor.

B. The client is at risk for heparin-induced thrombocytopenia; therefore, the care plan should include reporting evidence of bleeding or easy bruising. Feedback about possible bleeding and bruising from physical therapy and other caregivers should be incorporated into the care plan to ensure safety and optimal outcomes. Using a sequential compression device, mandating strict bed rest, and reporting signs of DVT don't incorporate collaborative care. Reporting signs of premature labor doesn't address the consequences of thrombocytopenia, which may occur with I.V. heparin therapy.

The nurse is working a cardiac care unit with a client on a diltiazem intravenous drip for atrial fibrillation. What are electrocardiogram (ECG) changes that suggest the client is responding to the treatment? Select all that apply. A. an absent P wave B. slowing heart rate C. T-wave inversion D. ST elevation E. decreasing R to R interval

B. slowing heart rate E. decreasing R to R interval The ECG changes that occur with an MI are seen in the leads that view the involved surface of the heart. The expected ECG changes are T-wave inversion, ST-segment elevation, and development of an abnormal Q wave. The diltiazem will slow the heart rate and decrease the R to R interval.

The nurse recognizes which as being true of cardioversion? A. Amount of voltage used should exceed 400 watts/second. B. Electrical impulse can be discharged during the T wave. C. Defibrillator should be set to deliver a shock during the QRS complex. D. Defibrillator should be set in the non-synchronous mode so the nurse can hit the button at the right time.

C. Defibrillator should be set to deliver a shock during the QRS complex.

A nurse should obtain serum levels of which electrolytes in a client with frequent episodes of ventricular tachycardia? A. Calcium and magnesium B. Potassium and calcium C. Magnesium and potassium D. Potassium and sodium

C. Magnesium and potassium Hypomagnesemia as well as hypokalemia and hyperkalemia are common causes of ventricular tachycardia. Calcium imbalances cause changes in the QT interval and ST segment. Alterations in sodium level don't cause rhythm disturbances.

The nurse is caring for a client with heart failure who has been prescribed digoxin. What laboratory value for the client can precipitate digoxin toxicity? A. Sodium 128 milliequivalents per liter B. Sodium 155 milliequivalents per liter C. Potassium 3.0 milliequivalents per liter D. Potassium 5.6 milliequivalents per liter

C. Potassium 3.0 milliequivalents per liter The serum potassium level is monitored because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity may occur. A potassium level of potassium 3.0 milliequivalents per liter is low or hypokalemic. A potassium level of 5.6 is high or hyperkalemic. The sodium levels do not precipitate digoxin toxicity.

The nurse is attempting to determine the ventricular rate and rhythm of a patient's telemetry strip. What should the nurse examine to determine this part of the analysis? A. TP interval B. PP interval C. RR interval D. QT interval

C. RR interval The rhythm is often identified at the same time the rate is determined. The RR interval is used to determine ventricular rhythm and the PP interval to determine atrial rhythm. If the intervals are the same or if the difference between the intervals is less than 0.8 seconds throughout the strip, the rhythm is called regular. If the intervals are different, the rhythm is called irregular.

The nurse is caring for a client admitted with angina who is scheduled for cardiac catheterization. The client is anxious and asks the reason for this test. The nurse should explain that cardiac catheterization is most commonly done for which purpose? A. To evaluate cardiovascular response to stress B. To detect how efficiently a client's heart muscle contracts C. To assess how blocked or open a client's coronary arteries are D. To evaluate cardiac electrical activity

C. To assess how blocked or open a client's coronary arteries are Cardiac catheterization is usually used to assess coronary artery patency to determine whether revascularization procedures are necessary. A thallium stress test shows myocardial ischemia after stress. An ECG shows the electrical activity of the heart.

A client with heart failure is taking an angiotensin-converting enzyme inhibitor (ACE-I) and reports a nagging cough. Which replacement medication will the nurse expect to be prescribed for this client? A. Metoprolol B. Spironolactone C. Diltiazem D. Losartan

D. Losartan An adverse effect of ACE inhibitors includes a dry, persistent cough that may not respond to cough suppressants due to the inhibition of the enzyme kininase, which inactivates bradykinin. If the client cannot continue taking an ACE inhibitor because of development of a cough, an angiotensin receptor blocker (ARB) is prescribed, such as losartan. A beta-adrenergic blocker, such as metoprolol, or aldosterone antagonist, such as spironolactone, are not prescribed for the client experiencing the adverse effect of a cough from an ACI inhibitor. Calcium channel blockers, such as diltiazem, are not used to treat heart failure.

A young mother with a 2 year old and a 6 month old is experiencing fatigue related to anemia. The client states that she is having difficulty performing the activities needed for her job, family, and home. With what task is it most appropriate for the nurse to assist the client? A. Finding a babysitter to take care of her children B. Requesting a leave of absence from her job C. Obtaining assistance from someone to help with cleaning in the home. D. Prioritizing and balancing activities and rest

D. Prioritizing and balancing activities and rest Fatigue is the most common symptom and complication of anemia. The nurse should assist the client to prioritize activities and to establish a balance between activity and rest that the client finds acceptable. With the other options, the nurse is jumping to conclusions that these things will help the client.