Nursing 3 Final - Cardiovascular
1. The nurse knows the heart's normal conduction system starts where? A. Sinoatrial (SA) node B. Artioventricular (AV) node C. Bundle of His D. Purkinje fibers
Answer: A
2. Blood pressure is controlled by the following factors: A. Vascular resistance, blood volume B. Systolic pressure, diastolic pressure C. RASS, blood viscosity D. Vasodilation, diastolic pressure
Answer: A
2. The myocardial tissue perfusion occurs during what phase of the cardiac cycle? A. Diastole B. Systole and Diastole C. Systole D. Ventricle depolarization
Answer: A
3. Perfusion at the tissue level is done through the abundant network of: A. Capillaries B. Arteries C. Arterioles D. Venules
Answer: A
4. The nurse caring for Mr. Smith knows that adequate glucose control is essential for CAD management because: A. Hyperglycemia is a modifiable risk factor for CAD B. Uncontrolled hyperglycemia can lead to ketoacidosis C. Hyperglycemia stimulates insulin resistance D. Hyperglycemia increases susceptibility to infection
Answer: A
CONNECTION CHECK 32.2 The charge nurse is monitoring the care of several critically ill patients in the ICU. Which patient requires immediate intervention by the provider? A. The patient with a PA catheter remaining in the wedge position B. The patient with an SvO2 of 55% C. The patient with an SVR of 1,300 D. The patient with a CO of 3.2
Answer: A Rationale: All of the above patient situations are slightly abnormal, requiring attention, but a pulmonary artery catheter that remains in a wedge position may indicate the possibility of pulmonary artery occlusion requiring repositioning or discontinuation of the catheter. Below mixed venous oxygen saturation and cardiac output may indicate the need for volume or inotropic support. The slightly increased systemic vascular resistance would need to be evaluated for cause, such as hypovolemia, and treated as necessary.
CONNECTION CHECK 28.5 What is the most likely procedure to determine the cause of severe chest pain in the patient newly admitted to the hospital? A. Coronary angiography B. Nuclear stress testing C. Right heart catheterization D. TEE
Answer: A Rationale: Coronary angiography is done to specifically evaluate the coronary arteries. Stress testing evaluates heart functioning during times of increased workload. Right heart catheterization evaluates cardiac filling pressures, cardiac output, and valvular function. Transesophageal echo evaluates the posterior aspect of the heart and the presence of clots.
CONNECTION CHECK 28.1 What is the composition of the heart? A. Four chambers with four valves that control flow through the heart and lungs through changes in pressure B. Four chambers and four valves that control flow through the heart and lungs through changes in oxygen levels C. Two chambers on the right receiving blood from the high-pressure venous system and two chambers on the left sending blood into the low-pressure arterial system D. Two chambers on the right receiving oxygenated blood from the venous system and two chambers on the left receiving deoxygenated blood from the pulmonary circuit
Answer: A Rationale: Flow through the heart is controlled through changes in pressure, not oxygen. The arterial system is a high-pressure system; the venous system is a low pressure system. Deoxygenated blood is returned to the right heart to be circulated through the lungs for gas exchange—oxygenated blood then flows through the left heart to the systemic circulation.
3. On the basis of the patient's diagnosis of cardiomyopathy, which condition should the nurse anticipate as a potential problem? A. Heart failure B. Diabetes mellitus C. Myocardial infarction D. Pericardial effusion
Answer: A Rationale: Heart failure is a common result with cardiomyopathy due to decreased pumping ability of the heart.
2. In reviewing the above orders, it is a priority for the nurse to follow up with the provider about which order? A. Lasix B. Dopamine drip C. ABG D. Second IV
Answer: A Rationale: If a patient is hypotensive they will not tolerate diuresis. Diuresis could worsen the hypotension and cardiac output.
3. The nurse has just received a report on assigned patients. Which of the following patients should be assessed first? A. The patient with indigestion and increased troponin levels B. The patient with indigestion and increased CK levels C. The patient admitted 2 days ago with a BNP of 75 pg/mL D. The patient admitted 2 days ago with increased LDLs and C-reactive protein
Answer: A Rationale: Indigestion is sometimes an indicator of myocardial infarction, and increased troponin levels are an indicator of acute injury. Increased CK is nonspecific for cardiac injury so the patient probably just has indigestion. The patient with a BNP of 75 two days after admission without shortness of breath is not acutely worrisome.
1. Prior to admission to the unit, Mr. More's BP is 180/122 mm Hg and he is complaining of a headache and blurry vision. These signs and symptoms combined with his laboratory results suggest a concern for which of the following? A. Hypertensive emergency B. Stroke C. Hypertension urgency D. Diabetes
Answer: A Rationale: Mr. More meets the criteria of a hypertensive emergency due to his diastolic BP of 122 and indications of target organ damage. A patient with hypertensive urgency does not have signs of TOD. Diabetes is considered when the blood sugar is consistently high requiring medication and/or diet and exercise for control. Stroke is considered when there are signs of neurological damage such as weakness, loss of vision, dizziness, ataxia, or dysphasia.
2. Upon admission, Mr. More's BP is 188/100 mm Hg. Which order is most important for the nurse to implement first? A. Administer labetalol 400 mg PO. B. Obtain a finger stick glucose reading. C. Begin oxygen via nasal cannula at 2 L. D. Administer Lipitor 40 mg PO.
Answer: A Rationale: Mr. More's antihypertensive medication is the priority to start to decrease his blood pressure and prevent risk of an acute event. A glucose level and administering his statin are important, but not immediate priorities. He does not currently need O2 because his sat is 96%.
4. Which instructions are appropriate for Mr. Smith? A. Lose weight, exercise, limit alcohol B. Prepare for coronary angiography C. Schedule an ambulatory ECG D. Plan for a TEE
Answer: A Rationale: Mr. Smith's physical is unremarkable so he does not require further invasive testing. He does need to lose weight, exercise, and limit alcohol to help reduce blood pressure.
3. The nurse understands Mr. Thompson's prn sublingual nitroglycerin decreases chest pain through which mechanism of action? A. Dilating the coronary arteries to improve blood flow B. Decreasing preload to relieve symptoms of dyspnea C. Decreasing heart rate to decrease cardiac workload D. Converting atrial fibrillation into sinus rhythm
Answer: A Rationale: Nitroglycerin does dilate the coronary arteries improving blood flow to the myocardium decrease in chest pain. It also decreases preload but that is more effective for decreasing dyspnea. It does not decrease heart rate or convert atrial fibrillation.
CONNECTION CHECK 32.4 A nurse is caring for a patient with a diagnosis of MI. The patient calls the nurse because he is experiencing chest pain. The nurse administers an SL nitroglycerin tablet as prescribed. After 5 minutes, the chest pain is unrelieved by the nitroglycerin. The next nursing action is which of the following? A. Administer another nitroglycerin tablet. B. Increase the flow rate of the oxygen. C. Contact the provider. D. Call the charge nurse.
Answer: A Rationale: Nitroglycerine can typically be repeated three times and should be attempted first.
CONNECTION CHECK 32.5 A 68-year-old male presents to the emergency department with complaints of crushing chest pain that radiates to the left shoulder. The patient is diagnosed with AMI. Admission orders include oxygen 2 L via nasal cannula, blood work, chest x-ray, 12-lead ECG, and SL nitroglycerin. What should be the nurse's first action? A. Apply oxygen. B. Obtain the 12-lead ECG. C. Administer the nitroglycerin. D. Obtain the blood work.
Answer: A Rationale: Oxygen is the first priority in an attempt to increase O2 levels and improve oxygen delivery to the heart.
1. The nurse has received the following orders for Mr. Thompson. Which order should the nurse implement first? A. Furosemide (Lasix) 40 mg IV B. Insert a Foley catheter C. Weight on admission D. ECG
Answer: A Rationale: Patient is tachypneic with labored breathing. Lasix will reduce fluid overload hoping to decrease respiratory distress. Airway breathing is the priority
CONNECTION CHECK 32.10 The nurse understands that a/an is used in the evaluation of cardiogenic shock. A. PA catheter B. LVAD C. RVAD D. IABP
Answer: A Rationale: Pulmonary artery catheter is a tool to evaluate treatment; the others are treatment modalities.
CONNECTION CHECK 30.1 What should the nurse anticipate when a diagnostic coronary angiogram reveals a 50% occlusion in the right coronary artery? A. A percutaneous coronary angioplasty with stent placement B. Emergent coronary artery bypass graft C. A follow-up stress test after initiation of medical management D. Medical management with only statins and nitroglycerin
Answer: A Rationale: The patient needs definitive treatment beyond follow-up or medications but does not yet require surgery.
4. The nurse is screening patients for their risk of developing heart disease. The nurse should consider which patient at greatest risk? A. A 60-year-old obese male smoker with a family history of heart disease B. A 40-year-old female who drinks two glasses of wine every day C. A 70-year-old male smoker with a long-standing history of hypertension D. A 50-year-old female smoker with a family history of heart disease
Answer: A Rationale: Patient has three risk factors for heart disease
CONNECTION CHECK 29.5 The nurse understands that rhythms originating in the ventricle have which of the following characteristics? (Select all that apply.) A. Wide QRS complexes B. Narrow QRS complexes C. Only QRS complexes D. Only fast rates E. Only slow rates
Answer: A and C Rationale: Rhythms originating in the ventricles can be slow or fast, have wide QRS complexes, and sometimes only have QRS complexes (VT). Narrow QRS complexes indicate rhythm originating above the AV node.
5. What information should be included in the teaching plan for Mr. Smith? (Select all that apply.) A. Check your BP frequently. B. Start running as an exercise program immediately. C. A diet limiting carbohydrates in favor of fats and proteins is advisable. D. If you must drink, limit it to one drink per day. E. If you must drink, beer is better than wine.
Answer: A and D Rationale: Mr. Smith should check his blood pressure frequently since he has stage I hypertension and may need to begin antihypertensives and limiting alcohol to one drink per day is recommended. An exercise program should be started slowly and increased as tolerated. Beer is not recommended over wine or vice versa.
CONNECTION CHECK 29.3 Key patient teaching points for AF include which of the following? (Select all that apply.) A. Medications for HR control B. Bleeding precautions C. Signs and symptoms of AF with RVR D. Cardioversion E. Defibrillation
Answer: A, B, C, and D Rationale: Medications may be used for rate control. AF patients are typically on anticoagulants. A rapid ventricular response may occur with AF, resulting in adverse symptoms and decreased cardiac output. Cardioversion, not defibrillation, is sometimes indicated for AF.
CONNECTION CHECK 29.2 As the nurse caring for a patient on a cardiac monitor, you understand which of the following steps are necessary to correctly identify the rhythm? (Select all that apply.) A. Determine the rate. B. Determine the regularity. C. Determine if there is a QRS for every P wave. D. Determine if there is a P wave for every QRS. E. Determine if there is a U wave for every QRS.
Answer: A, B, C, and D Rationale: Determine rate, rhythm, and the presence of P waves and QRS complexes are important components of rhythm identification. There might not always be a U wave following every QRS.
4. The nurse caring for Ms. Fletcher incorporates which nursing diagnosis into the plan of care? (Select all that apply.) A. Risk for decreased cardiac output B. Risk for embolic event C. Knowledge deficit D. Risk for poor nutrition E. Risk for bleeding
Answer: A, B, C, and E Rationale: All except D are priority diagnoses. AF puts the patient at risk for clots, thus an embolic event, decreased cardiac output due to the loss of atrial kick, and good knowledge of the diagnosis of AF and necessary self-care is essential for health maintenance.
2. The nurse includes which information in the teaching plan about the management of warfarin? (Select all that apply.) A. Checking urine for blood B. Using an electric razor when shaving C. Using a hard toothbrush for effective plaque removal D. Avoiding any activity or sport that may cause traumatic injury E. Avoiding kale, spinach, collard greens, broccoli, okra, cabbage
Answer: A, B, D, and E Rationale: A: Bleeding risk with Coumadin should check for blood in urine to assess for internal bleeding; B, D: use electric razor, and avoid dangerous activities to reduce risk of bleeding; E: foods containing vitamin K increase platelet aggregation and has the opposite effect of warfarin, decreasing the medications effectiveness and increasing risk for clot formation. A hard tooth brush may cause bleeding.
5. While educating a patient about AF, the nurse informs the patient that which of following can be symptoms of AF? (Select all that apply.) A. Shortness of breath B. Hypotension C. Weight loss D. Dizziness E. Sweating
Answer: A, B, D, and E Rationale: Weight loss is not a symptom of AF. Shortness of breath, diaphoresis, hypotension, and dizziness are all signs of decreased cardiac output associated with AF.
3. Stroke volume is influenced by which variables? (Select all that apply.) A. Preload B. Afterload C. Contractility D. Heart rate E. Cardiac output F. Chemoreceptors
Answer: A, B, and C
CONNECTION CHECK 29.4 Which of the following is not an appropriate intervention for all atrial dysrhythmias? A. An ECG B. A pulse check C. Blood pressure D. Cardioversion
Answer: A, B, and C Rationale: An ECG, pulse, and blood pressure check are key assessment parameters. Cardioversion is only used with symptomatic atrial dysrhythmias.
1. The nurse monitors for which clinical manifestations in the patient diagnosed with MI? (Select all that apply.) A. Chest pain B. Nausea C. Diaphoresis D. Hypertension E. Bounding pulses
Answer: A, B, and C Rationale: Chest pain, nausea, and diaphoresis are common clinical manifestations in a patient having an MI. The patient is typically hypotensive and bleeding is not an issue. Cardiac output is low so pulses would be weak.
2. The nurse monitors for which clinical manifestations in Ms. Fletcher? (Select all that apply.) A. Complaints of palpitations B. Complaints of shortness of breath C. Diaphoresis D. Fever E. Hyperglycemia
Answer: A, B, and C Rationale: Diaphoresis, shortness of breath, and palpitations may indicate the return of AF.
5. The nurse providing care for Mr. Thompson should include which of the following into the discharge teaching plan? (Select all that apply.) A. Sodium restriction B. Daily weight C. Medication teaching D. Vigorous daily exercise E. Carbohydrate counting
Answer: A, B, and C Rationale: Education about these measures may potentially improve adherence to course and treatment and prevent readmission for HF exacerbation. Carbohydrate counting may be used if patient is diabetic. The patient should be encouraged to engage in light to moderate exercise, not vigorous.
3. On the basis of patient history and the results of diagnostic tests, what are the priority assessments for Mr. More? (Select all that apply.) A. Strict intake and output B. Vital signs C. Finger stick blood glucose D. Cranial nerve assessment E. Swallowing evaluation
Answer: A, B, and C Rationale: Frequent blood pressure assessments are necessary due to this hypertension. His creatinine and BUN were elevated initially indicating renal failure, so intake and output is a priority. His blood glucose was elevated on admission requiring continued monitoring. There are no acute neurological changes evident that would make cranial nerve assessment or swallowing evaluation a priority.
3. Mr. Smith's BP increases his risk of heart disease through what action(s)? (Select all that apply.) A. Prolonged increased afterload B. Prolonged increased stress on vasculature C. Increased cardiac workload D. Increased automaticity E. Decreased contractility
Answer: A, B, and C Rationale: Prolonged increases in afterload that occurs with hypertension increases workload on the heart, and hypertension produces prolonged stress on the vasculature; both increase the risk of heart disease. Decreased contractility occurs as a result of heart disease. Increased automaticity is not associated with hypertension.
CONNECTION CHECK 31.1 A patient teaching plan should focus on which risk factors for atherosclerosis? (Select all that apply.) A. Obesity B. Hyperlipidemia C. Smoking D. Age E. Race
Answer: A, B, and C Rationale: The patient teaching plan should focus on risk factors that the individual can have an impact on changing. Patients have the opportunity to impact their weight, lipid levels, and smoking. Patients are not able to modify their age or race.
CONNECTION CHECK 32.7 The nurse monitors for which complications in patients with cardiomyopathy? (Select all that apply.) A. Ventricular dysrhythmias B. Stroke C. Pericarditis D. Pulmonary embolism E. Pleural effusion
Answer: A, B, and D Rationale: Pericarditis and pleural effusion are not complications of cardiomyopathy.
CONNECTION CHECK 29.9 Signs or symptoms of symptomatic ventricular dysrhythmias include which of the following? (Select all that apply.) A. Hypotension B. Dizziness C. Fever D. Shortness of breath E. Hypertension
Answer: A, B, and D Rationale: Shortness of breath, hypotension, and dizziness are present with symptomatic ventricular dysrhythmias.
CONNECTION CHECK 31.8 Which statements by a patient with an AAA indicate that teaching has been effective? (Select all that apply.) A. "I need to quit smoking." B. "I need to go to the emergency department immediately if I have new severe abdominal pain." C. "The doctor may put me on blood thinners." D. "I need to stay on my blood pressure medication." E. "I should keep my legs elevated whenever possible."
Answer: A, B, and D Rationale: Smoking is the most modifiable risk factor. Abdominal pain may indicate an emergent need for resection or progression towards aortic dissection. Antihypertensives reduce blood pressure and the pressure placed on the aneurysm, therefore slowing the progression. Crossing or elevating the legs increases the pressure in the intrathoracic and abdominal area.
1. What are Mr. Smith's modifiable risk factors? (Select all that apply.) A. Weight B. Family history of heart disease C. Dietary patterns D. Drinking history E. Homocysteine levels
Answer: A, C, and D Rationale: Weight, diet, and alcohol consumption are all modifiable risk factors.
CONNECTION CHECK 31.2 The nurse is screening patients for their risk of developing hypertension. The nurse should consider which patients at greatest risk? (Select all that apply.) A. A 40-year-old Latino male who is obese and smokes two packs of cigarettes per day B. A 35-year-old Asian female who has a familial history of diabetes mellitus type 1 C. A 78-year-old African American male with chronic renal insufficiency D. A 25-year-old African American female track athlete with a healthy body mass index (BMI) who takes oral contraceptives E. A 60-year-old Caucasian male with vitamin D deficiency and a history of cocaine use
Answer: A, C, and E Rationale: Patient A has the three major risk factors of gender (male), cigarette smoking, and obesity. Recent studies claim that obesity is a risk factor for hypertension because of the activation of the RAAS and SNS in adipose tissue. The nicotine in cigarettes causes SNS activation and vasoconstriction.
CONNECTION CHECK 28.4 A nurse is providing care for a patient newly diagnosed with heart disease. Which dietary, activity, or lifestyle modification(s) should be included in the plan of care? (Select all that apply.) A. Stop smoking. B. Drink lots of water. C. Limit sedentary lifestyle. D. Eat a diet rich in red meat protein. E. Limit alcohol.
Answer: A, C, and E Rationale: Smoking, exercise, and alcohol intake are modifiable risk factors for heart disease. Patients should not be told to drink lots of water as the heart may not be able to handle excessive fluids. A diet rich in red meat is a risk factor.
CONNECTION CHECK 29.7 What do second-degree and third-degree heart blocks have in common? A. Wide QRS complexes B. Narrow QRS complexes C. Dropped QRS complexes D. No commonalities
Answer: D Rationale: There are no commonalities. There is a connection between the atria and ventricles in second degree blocks. In third degree blocks, the atria and ventricles are working independently.
CONNECTION CHECK 31.7 A nurse is assessing a patient in the emergency department with the complaint of sudden onset of severe back pain, tachycardia, and hypotension. Which interventions should the nurse anticipate? (Select all that apply.) A. Electrocardiogram B. Aortic arteriography C. Ultrasonography D. Chest x-ray E. Computed tomography scan
Answer: A, C, and E Rationale: Ultrasonography can be done quickly and efficiently at the bedside to rule out aortic dissection. CT scan may also be done to definitively diagnose or rule out aortic dissection. An ECG is necessary to rule out MI. Aortic arteriography is a highly invasive and lengthy procedure at a time when quick and uncomplicated is essential. CXR cannot provide definitive diagnosis of aortic dissection.
1. Arteries bring and from the heart to tissues. A. deoxygenated blood and electrolytes B. oxygenated blood and nutrients C. red blood cells and waste products D. deoxygenated blood and nutrients
Answer: B
2. The nurse recognizes the QRS complex represents what? A. Atrial depolarization B. Ventricular depolarization C. Atrial repolarization and ventricular depolarization D. Atrial depolarization and ventricular repolarization
Answer: B
CONNECTION CHECK 32.1 The nurse is managing the care of a patient with an arterial line. Which assessment finding warrants immediate intervention by the nurse? A. A dampened or flat waveform on the monitor B. Tubing disconnected from the arterial line C. IV medications being infused into an arterial line D. Redness at the arterial line insertion site
Answer: B Rationale: All of the findings indicate a problem, but disconnected tubing may result in hemorrhage requiring immediate intervention. Intravenous medications through the arterial line should be stopped as soon as possible. A dampened or flat waveform requires assessment of positioning or air in the line. Redness at the site indicates possible inflation and may require the line be discontinued.
CONNECTION CHECK 30.4 In a report, the nurse is told the patient has a systolic murmur that sounds like turbulent flow. On the basis of this description, which of the following might be a problem? A. Aortic regurgitation B. Aortic stenosis C. Pericarditis D. Infective Endocarditis
Answer: B Rationale: Aortic stenosis produces a "turbulent" systolic sound.
1. What laboratory values are significant indicators of acute heart injury? A. Increased CK and myoglobin B. Increased CK-MB and troponin C. Decreased BNP and platelets D. Increased CK with low levels of CK-MB
Answer: B Rationale: CK-MB and troponin are increased in acute injury, CK and myoglobin are nonspecific for cardiac injury, increased BNP is an indicator of heart failure. Increased CK is not specific for heart injury. Low levels of CK-MB indicates the damage is not cardiac.
2. Your patient requires immediate cardioversion, which is defined as which of the following? A. A controlled electrical shock that is triggered by and fires on the P wave B. A controlled electrical shock that is triggered by and fires on the R wave C. A controlled electrical shock that is triggered by and fires on the T wave D. An electrical shock that fires randomly during the cardiac cycle
Answer: B Rationale: Cardioversion is a controlled electrical shock that is triggered by and fires on the R wave, not the P wave or T wave. Firing on the T wave could result in lethal arrhythmias. An electrical shock that fires randomly is defibrillation.
1. What is the priority nursing action for Ms. Fletcher upon admission to the unit? A. Orientation to the room B. Initiating ECG monitoring C. Calculating intake and output D. Assessing pain level
Answer: B Rationale: Continuous ECG monitoring is the priority to monitor for the return of AF
3. The charge nurse is reviewing new admission orders for Ms. Fletcher. It is a priority for the charge nurse to follow up with the provider about which order? A. Regular diet B. Discontinue monitor C. Vital signs every 4 hours D. Saline lock
Answer: B Rationale: Continuous monitoring is necessary to monitor for the return of AF or other dysrhythmias. VS Q4h, regular diet, and a saline lock are all indicated for her care.
1. A patient returning from heart catheterization has a slight increase in serum creatinine from 1.0 to 1.2 mg/dL and a blood urea nitrogen (BUN) of 30 mg/dL (previously 22 mg/dL). The nurse anticipates an order for which medication? A. Nitroglycerin (Tridil) B. IV hydration C. Dialysis D. Furosemide (Lasix)
Answer: B Rationale: Contrast induced nephropathy is a potential complication of heart catheterization. It is evidenced by increased Cr/BUN and requires IV hydration to augment flow to the kidneys to flush out the dye. Tridil is for chest pain, dialysis is not indicated at this point, and Lasix would further the problem by eliminating volume.
4. A patient has VF. The nurse understands that the most effective treatment besides CPR is which of the following? A. Antiarrhythmics B. Defibrillation C. Ventilation D. Epinephrine
Answer: B Rationale: Defibrillation is necessary to stop VF and hope for a return to a perfusing rhythm. Antiarrhythmics, epinephrine, and ventilation are all a part of the resuscitation after defibrillation.
5. Which statement by the patient about his medication regimen indicates the need for further teaching? A. "I will call my doctor if I am dizzy and short of breath." B. "I will take my BP medication only if my blood pressure is up." C. "One of my medications, Lasix, will make me urinate a lot." D. "I am able to take my labetalol and lisinopril at the same time."
Answer: B Rationale: His care provider should give him parameters, but the patient should take his BP medication even if his BP is in the normal range to keep a consistent effect as long as he is asymptomatic.
CONNECTION CHECK 28.3 A patient with hypertension has which physical symptom? A. Decreased resistance, which may increase CO B. Increased resistance, which may decrease CO C. Increased resistance, which may increase CO D. Decreased resistance, which may decrease CO
Answer: B Rationale: Hypertension increases resistance. Increase resistance may decrease cardiac output. Decreased resistance may increase cardiac output.
4. The nurse should intervene immediately if patient with DVT is noted to: A. Have redness and warmth in lower calf of right leg B. Experience new shortness of breath and a decrease in O2 sat C. Have pain and tenderness in right thigh D. Begin having nausea and diarrhea
Answer: B Rationale: If the patient is experiencing new shortness of breath and a decrease in O2 there is concern for a PE which is an emergency and needs immediate intervention. The redness and warmth in the lower calf of the right leg is having normal signs and symptoms of the DVT. Nausea and diarrhea are unrelated to DVT.
CONNECTION CHECK 32.9 What action of IABP therapy supports cardiac function? A. Inflating the balloon during systole, increasing CO B. Inflating the balloon during diastole, improving coronary circulation C. Deflating the balloon during diastole, decreasing SVR D. Deflating the balloon during systole, improving coronary circulation
Answer: B Rationale: Inflating the balloon during diastole, improving coronary circulation, pushed blood into the coronaries and systemic circulation; inflating the balloon during systole increases resistance, harmful to cardiac output; deflating the balloon during diastole or deflating the balloon during systole does not improve coronary circulation and does not have a beneficial effect on resistance.
CONNECTION CHECK 31.5 The nurse is reviewing orders for a newly admitted patient with PAD in the right lower extremity. The nurse should follow up with the provider about which order? A. Begin Trental 400 mg PO twice daily with meals. B. Keep the affected extremity elevated. C. Begin lisinopril 10mg PO daily. D. Encourage light exercise as tolerated.
Answer: B Rationale: The affected extremity should be kept dependent to maintain adequate blood flow.
1. The nurse should intervene if a patient with AAA is noted to experience: A. Mild back pain, increased BP, decreased RBC B. Severe lower back pain, decreased BP, decreased RBC C. Intermittent lower back pain, decreased BP, decreased RBC D. Severe lower back pain , increased BP, increased RBC
Answer: B Rationale: The patient is having an aortic dissection. The nurse identifies this due to classic clinical signs and symptoms. The shearing force and tearing of the aorta causes severe lower back or abdominal pain. BP decreases due to hypovolemia from blood loss from the central venous system. RBCs decrease due to profuse blood loss.
1. The nurse has received the following provider orders for a patient in cardiogenic shock with a blood pressure of 70/35 mm Hg. Which order should the nurse implement first? A. Lasix 40 mg IV push B. Dopamine IV drip C. Obtain ABG D. Insert second IV
Answer: B Rationale: The patient is hypotensive and needs immediate blood pressure support. Therefore, the Dopamine would be the first intervention.
2. The nurse anticipates what procedure for the patient at risk for stroke because of the potential presence of blood clots in the right atrium? A. Nuclear stress test B. TEE C. Coronary angiography D. CXR
Answer: B Rationale: Transesophageal echocardiogram can identify the presence of clots, nuclear stress test identifies areas of poor perfusion, coronary angiography looks at blockages in the coronary arteries, and chest x-ray is a general screening exam which also can identify long injury or infection.
4. The nurse understands which of the following treatment plans may be considered for a newly admitted 65-year-old patient with aortic stenosis who is considered a poor surgical risk? A. Valve replacement B. Valvuloplasty C. Annuloplasty D. Commissurotomy
Answer: B Rationale: Valvuloplasty is a precutaneous procedure and may have lower risk compared to the traditional open heart valve surgery, the preferred option for this patient. A, C, and D require surgery, not the preferred option for this patient. The physician may have been documenting on the wrong chart.
5. What is the main purpose of the IABP? (Select all that apply.) A. Deflate during diastole to facilitate myocardial oxygen delivery B. Inflate during diastole to facilitate myocardial oxygen delivery C. Deflate during systole to decrease SVR D. Inflate during systole to increase blood pressure E. Deflate during systole to facilitate myocardial oxygen delivery
Answer: B and C Rationale: The balloon pump inflates during diastole to push blood into the coronaries to supply the heart with blood. It deflates during systole to decrease SVR and help increase blood pressure.
4. Priority teaching needs for Mr. More include which of the following? (Select all that apply.) A. Anticoagulation therapy B. Smoking cessation C. DASH diet D. Slow posture changes E. Eat a banana a day
Answer: B, C, D, and E Rationale: Smoking cessation and DASH diet are two modifiable risk factors that can improve Mr. More's outcome. Slow posture changes are important when on a beta blocker to reduce orthostatic hypotension and risk of fainting. Because Mr. More is on Lasix he will need to include more K+ in his diet. Mr. More is in sinus rhythm at this time and does not require anticoagulation treatment. Insulin treatment at this time is not necessary. The diabetes can be controlled with diet.
CONNECTION CHECK 29.1 As the nurse, you know that the following can cause rhythm disorders: (Select all that apply.) A. Exercise B. Electrolyte imbalances C. Myocardial hypertrophy D. Myocardial damage E. Eating red meat
Answer: B, C, and D Rationale: Myocardial infarction or damage, cardiomyopathy or hypertrophy, and electrolyte disturbances can lead to dysrhythmias.
CONNECTION CHECK 32.6 The nurse understands which of the following are symptoms of HCM? (Select all that apply.) A. Weakened contraction B. Poor filling C. Decreased cardiac output D. Impaired systolic function E. Impaired diastolic function
Answer: B, C, and E Rationale: In hypertrophic cardiomyopathy, muscle walls are thickened; contraction is not weakened, but filling is impaired (impaired diastolic function) resulting in decreased cardiac output.
1. Central venous pressure (CVP) is a reflection of: A. Afterload B. Contractility C. Preload D. Stroke volume
Answer: C
3. The nurse recognizes the artioventricular (AV) node generates electrical impulses at a rate of: A. ≤ 20 bpm B. ≤ 40 bpm C. 40-60 bpm D. 60-100 bpm
Answer: C
4. The patient with a PA catheter has a low pulmonary artery occlusive pressure. On the basis of this information, what intervention should the nurse anticipate? A. A diuretic to help decrease fluid volume overload B. A vasoactive drip to help increase blood pressure C. A fluid bolus to help increase preload D. An afterload reducer to help decrease SVR
Answer: C Rationale: A low PAOP indicates decreased preload in the left heart typically requiring volume. A vasoactive drip would increase blood pressure but not affect volume. An afterload reducer will decrease blood pressure. A diuretic would further decrease the PAOP.
5. Which statement by Ms. Fletcher indicates that teaching has been effective? A. "I'm just glad the problem was fixed, and I don't need to go back to the doctor." B. "I'm glad I don't have to worry about having a stroke anymore." C. "I guess I need to follow up with a heart doctor." D. "I guess things will go back to normal now."
Answer: C Rationale: AF may return so follow-up is an essential component of care.
CONNECTION CHECK 31.9 A patient has been admitted to the hospital for a PE. What is the priority nursing intervention? A. Insert an IV line. B. Begin heparin drip as ordered. C. Check oxygen saturation. D. Determine patient allergies.
Answer: C Rationale: Airway and breathing is the priority in this situation as PE can often cause a decrease in O2 saturation and severe SOB. After that you would want to confirm that patient has working central line and/or IV access, check allergy status for heparin allergy, and then initiate ordered heparin bolus and continuous infusion to prevent further clot formation.
2. On arrival to the emergency department, the nurse caring for Mr. King receives several orders from the provider. Which order should the nurse implement first? A. Morphine sulfate 2 mg IV B. Nitroglycerin tab SL C. Oxygen 2 L via nasal cannula D. Aspirin 325 mg chewed
Answer: C Rationale: All actions are important, but the priority is to support the patient's oxygenation—ABCs.
CONNECTION CHECK 30.2 The nurse determines which patient is at greatest risk for developing IE? A. A 22-year-old student undergoing a dental procedure B. A 35-year-old man with a past medical history of IV drug use C. A 65-year-old male heart transplant patient on immunosuppressive therapy undergoing a dental procedure D. A 70-year-old female with heart failure (HF) with an intravascular access device for home drug infusion
Answer: C Rationale: All are risk at risk, but patient A has very minimal risk where patient C has high risk due to immunosuppressive therapy and a dental procedure.
5. Altered levels of sodium, potassium, and calcium may result in what condition? A. Fluid loss B. Fluid retention C. Dysrhythmias D. Shortness of breath
Answer: C Rationale: Altered levels of one or all three will produce dysrhythmias due to disruptions in the action potential. Increased sodium can produce fluid retention or shortness of breath. Decreased sodium may produce fluid loss resulting in decreased potassium.
CONNECTION CHECK 31.6 A nurse is performing the immediate postoperative assessment of a patient who just underwent CEA. What is the most important assessment to be reported immediately? A. A complaint of 7/10 pain B. Falling back to sleep after assessment C. An asymmetric smile D. Complaint of a sore throat
Answer: C Rationale: An asymmetric smile may indicate damage to cranial nerve seven—the physician should be made aware immediately. Sleepiness is normal postanesthesia, a sore throat is not unusual post-intubation, and pain should be treated after notifying the physician about the asymmetric smile.
CONNECTION CHECK 28.6 What is an important nursing action post cardiac catheterization interventions? A. Early mobilization to prevent clot formation B. Fluid restriction to avoid fluid overload C. Bedrest to avoid stress on cannula insertion site D. Head of bed at 30 degrees for respiratory support
Answer: C Rationale: Avoiding stress at the cannula insertion site by maintaining flat bed rest helps reduce the incidence of bleeding. Encouraging fluids helps clear the contrast dye.
4. The nurse caring for the patient with cardiogenic shock incorporates which nursing diagnosis into the plan of care? A. Impaired tissue perfusion related to decreased circulating volume secondary to hypovolemia B. Impaired tissue perfusion related to decreased circulating volume secondary to peripheral vasodilation C. Impaired tissue perfusion related to decreased circulating volume secondary to poor contractile function of myocardial muscle D. Impaired tissue perfusion related to decreased circulating volume secondary to interrupted response of the sympathetic nervous system
Answer: C Rationale: Cardiogenic shock is caused by a weakened contractile function of cardiac muscle. Hypovolemic shock secondary to excessive loss of blood and fluid. Distributive shock is caused by massive peripheral vasodilatation, and neurogenic shock is caused by the inability of the sympathetic nervous system to respond.
2. The nurse correlates which finding with Mr. Thompson's atrial fibrillation with a heart rate of 120 to 140 beats per minute? A. Acute decompensation requiring immediate cardioversion B. The loss of atrial kick requiring fluid resuscitation C. Increased workload of the heart requiring beta blockers D. Acute decompensation requiring immediate cardiac catheterization
Answer: C Rationale: Elevated heart rate increases oxygen consumption and workload of the heart. Rate control with beta blockers is indicated.
CONNECTION CHECK 28.7 What information should be in the teaching plan of a 76-year-old patient after a physical? A. Initiating a new strenuous exercise regimen is recommended. B. Limit physical activity and exercise. C. Report any new or excessive fatigue. D. Excessive fatigue is not unusual as you age.
Answer: C Rationale: Excessive fatigue is not normal and may indicate the onset of heart failure. While physical activity should be continued, even if healthy, a new strenuous exercise regime should be carefully monitored.
5. The nurse is caring for a patient post emergent pericardiocentesis for pleural effusion. A drain was left in post procedure but has stopped draining. Which of the following actions should the nurse plan to take first? A. Irrigate the drain B. Clamp the drain C. Check vital signs D. Call for immediate assistance
Answer: C Rationale: Irrigating the drain is contraindicated - infectious risk. Clamping the drain contraindicated as it would make matters worse by cutting off the ability to drain. Calling for immediate assistance is the second action after obtaining vital signs.
3. A treatment goal for Mr. King is to decrease myocardial workload. What order should the nurse anticipate to accomplish this goal? A. Norepinephrine IV drip B. Dobutamine IV drip C. Metoprolol IV push D. Aspirin 325 mg
Answer: C Rationale: Metoprolol, a beta blocker, inhibits the response of the sympathetic nervous system effectively decreasing heart rate and decreasing myocardial oxygen consumption. Norepinephrine is a vasoconstrictor to help increase blood pressure, but it will also increase systemic vascular resistance increasing the workload of the heart. Dobutamine increases cardiac contractility. Aspirin helps decrease clot formation.
1. The nurse understands that the normal conduction pathway for the heart is which of the following? A. AV → SA → Ventricles → Purkinje fibers B. Purkinje fibers → AV → Ventricles → SA C. SA → AV → Ventricles → Purkinje fibers D. Ventricles → Purkinje fibers → SA → AV
Answer: C Rationale: SA → AV → Ventricles → Purkinje fibers is the normal conduction pathway
CONNECTION CHECK 31.3 Which statement by the patient about the need for anti-hypertensive medication indicates the need for further teaching? A. "I'm worried about a stroke if my BP is not controlled." B. "Can my kidneys fail if I don't control my BP?" C. "My BP is only slightly elevated so I am okay." D. "I guess I need to take this medication even if I feel okay."
Answer: C Rationale: Stroke and renal failure are complications of hypertension. Anti-hypertensives need to be taken all of the time! Even slight elevations in BP, pre-hypertension, require lifestyle changes.
CONNECTION CHECK 28.2 Which is true of the electrical conduction system of the heart? A. It is primarily controlled by the movement of uncharged ions. B. It has a positive resting membrane potential. C. It is reflected in the waveforms on the electrocardiogram. D. It requires cells that respond only to stimulus from the autonomic nervous system.
Answer: C Rationale: The electrical conduction system is controlled by the movement of charged ions across the cell membrane, has a negative resting membrane potential, and is composed of cells with the property of automaticity, which is reflected in the waveforms on the electrocardiogram.
3. The nurse is caring for a patient post carotid endarterectomy that is experiencing new onset hypotension. Which of the following actions should the nurse plan to take first? A. Assess Glasgow coma scale B. Head of bed at 30° C. Administer fluids as ordered D. Assess cranial nerves
Answer: C Rationale: The patient may be having a bleeding complication and will need fluids to help normalize BP while other definitive action is considered.
CONNECTION CHECK 31.4 A nurse providing care for a patient whose BP readings are consistently 130/85 mm Hg should anticipate which medical plan of care? A. Diagnostic testing for TOD B. Initiation of anti-hypertensive therapy C. Modifications of diet and exercise D. Echocardiogram
Answer: C Rationale: This patient is within the range for prehypertension. Hypertension can still be prevented with lifestyle changes or modifications such as DASH diet and an exercise regimen.
CONNECTION CHECK 29.8 Transcutaneous pacing should be considered for which of the following dysrhythmias? A. VF B. VT C. Symptomatic heart block D. AF
Answer: C Rationale: Transcutaneous pacing may be used in symptomatic block, causing bradycardia. VF and VT without a pulse require defibrillation. VT with a pulse and atrial fibrillation may require cardioversion if the patient is symptomatic.
CONNECTION CHECK 32.3 The nurse is reviewing the laboratory results of her patient and notes that a cardiac troponin level was drawn. This test was drawn to determine which diagnosis? A. Atrial fibrillation B. Ventricular tachycardia C. Myocardial infarction D. Congestive heart failure
Answer: C Rationale: Troponin levels are the best laboratory indicator of MI.
3. The nurse understands transcutaneous pacing is necessary for which symptomatic patient? A. Sinus tachycardia B. Sinus rhythm with PACs C. Atrial fibrillation D. Complete heart block
Answer: D Rationale: A symptomatic patient in complete heart block requires pacing to restore adequate cardiac output.
CONNECTION CHECK 32.8 The nurse questions which order for the patient with cardiomyopathy? A. ACE inhibitors B. Beta blockers C. Diuretics D. SL nitroglycerin
Answer: D Rationale: ACE inhibitors, beta blockers, and diuretics all decrease the workload of the heart which is beneficial in cardiomyopathy. There is a risk of hypotension with nitroglycerine due to vasodilatation.
3. The nurse is screening patients for their risk of developing IE. Patients abusing IV drugs are at greatest risk for which condition? A. Right-sided IE with pulmonic valve involvement B. Left-sided IE with mitral valve involvement C. Left-sided IE with aortic valve involvement D. Right-sided IE with tricuspid valve involvement
Answer: D Rationale: Drugs are injected into the venous circulation. Thus the right side is the common infectious site for the micro-organisms.
5. The nurse is taking care of four patients admitted for uncontrolled hypertension. Which of the following patients should the nurse see immediately? A. The patient with a BP of 200/95 that denies any symptoms but has a strong family history of stroke B. The patient with a BP of 158/95 with an elevated BUN and creatinine complaining of nocturia C. The patient with a BP of 162/75 complaining of noticeable vision impairment in the left eye over the last 2 months D. The patient with a BP of 155/92 complaining of left sided weakness, facial drooping, and slurred speech
Answer: D Rationale: Even though patient D's BP is lower than the other patients, patient D is experiencing symptoms of a right sided stroke and should be immediately placed on stroke protocol. This is an emergency. The other patients require significant intervention as well but are stable at this time and are experiencing chronic effects.
2. What statement indicates further teaching is necessary? A. "My family history makes me worry." B. "Changing my eating habits is hard." C. "I will talk with my doctor before starting an exercise program." D. "My blood pressure is not so high."
Answer: D Rationale: Mr. Smith has stage I hypertension so will need to monitor his blood pressure closely. He accurately understands his family history puts him at risk, he needs to consult his physician before exercise, and changing eating habits is not easy.
CONNECTION CHECK 30.3 The nurse should intervene immediately if a patient with pericarditis is noted to do which of the following? A. A complaint of pain B. A fever C. Diaphoresis D. Hypotension
Answer: D Rationale: Pain, fever, and diaphoresis are all manifestations of pericarditis. Hypotension may indicate worsening effusion leading to tamponade.
2. What order should a nurse anticipate when caring for an HF patient with cold extremities, poor mentation, hypotension, and no urine output? A. Diuretics B. Afterload reducer C. Beta blocker D. Inotropic support
Answer: D Rationale: Patient is experiencing decompensated heart failure and requires medication to improve cardiac output. Diuretics, afterload reduction, and beta blockers may be one response, but a more aggressive treatment is necessary with this patient.
4. Which statement by Mr. Thompson indicates that teaching about hyperkalemia has been effective? A. "The water pill makes my potassium level high." B. "I should eat bananas because they make my potassium go down." C. "My liver is not working, so it holds onto the potassium." D. "My kidneys are not working because my heart is weak."
Answer: D Rationale: The decreased cardiac output from the heart failure resulted in renal insufficiency possibly causing hyperkalemia. All other statements are incorrect which would indicate teaching was not effective.
CONNECTION CHECK 30.5 The nurse understands that symptoms of SOB, crackles, dependent edema, and jugular vein distention are hallmark features of: A. Left-sided HF B. Right-sided HF C. Ischemic cardiomyopathy D. Biventricular failure
Answer: D Rationale: This patient has signs of both right (dependent edema, JVD) and left (SOB, crackles) sided heart failure—biventricular failure.
CONNECTION CHECK 29.6 Which of the following dysrhythmias requires defibrillation? A. Atrial tachycardia B. Atrial fibrillation C. Ventricular tachycardia with a pulse D. Ventricular fibrillation
Answer: D Rationale: VF requires defibrillation. Atrial tachycardia or fibrillation or ventricular tachycardia with a pulse may require cardioversion if the patient is symptomatic.
CONNECTION CHECK 31.10 The nurse is caring for a patient on a heparin drip who was admitted for DVT 2 days ago. Which laboratory value is most important to report to the provider immediately? A. A normal INR B. An increased hematocrit C. An increased platelet count D. A normal aPTT
Answer: D Rationale: aPTT is used to monitor heparin effectiveness. A normal value indicates the need to increase the dose.
