Practice Questions - Ch 22, 23 ,25
The pain of angina pectoris is produced primarily by: a. coronary vasoconstriction. b. movement of thromboemboli. c. myocardial ischemia. d. the presence of atheromas
a. coronary vasoconstriction.
Calcium channel blockers act by :a. decreasing SA node automaticity. b. increasing AV node conduction. c. increasing the heart rate. d. creating a positive inotropic effect.
a. decreasing SA node automaticity
Extremity paresthesia, dysrhythmias (peaked T waves), and mental confusion after cardiac surgery aresigns of electrolyte imbalance related to the level of: a. calcium. b. magnesium .c. potassium. d. sodium.
.c. potassium.
When assessing the patient with pericardial effusion, the nurse will assess for pulsus paradoxus. Pulsus paradoxus is characterized by what assessment finding? A diastolic blood pressure that is lower during exhalation A diastolic blood pressure that is higher during inhalation A systolic blood pressure that is higher during exhalation A systolic blood pressure that is lower during inhalation
A systolic blood pressure that is lower during inhalation****
A patient is brought to the ED and determined to be experiencing symptomatic sinus bradycardia. The nurse caring for this patient is aware the medication of choice for treatment of this dysrhythmia is the administration of atropine. What guidelines will the nurse follow when administering atropine? A. Administer atropine 0.5 mg as an IV bolus every 3 to 5 minutes to a maximum of 3.0 mg. B. Administer atropine as a continuous infusion until symptoms resolve. C. Administer atropine as a continuous infusion to a maximum of 30 mg in 24 hours. D. Administer atropine 1.0 mg sublingually.
Ans: A Feedback:Atropine 0.5 mg given rapidly as an intravenous (IV) bolus every 3 to 5 minutes to a maximum total dose of 3.0 mg is the medication of choice in treating symptomatic sinus bradycardia. By this guideline, the other listed options are inappropriate.
The nurse is caring for a patient who has developed obvious signs of pulmonary edema. What is the priority nursing action? Lay the patient flat. Notify the family of the patient's critical state. Stay with the patient. Update the physician.
Stay with the patient. Because the patient has an unstable condition, the nurse must remain with the patient. The physician must be updated promptly, but the patient should not be left alone in order for this to happen. Supine positioning is unlikely to relieve dyspnea. The family should be informed, but this is not the priority action.
Patients who are taking beta-adrenergic blocking agents should be cautioned not to stop taking their medications abruptly because which of the following may occur? a) Worsening angina b) Internal bleeding c) Thrombocytopenia d) Formation of blood clots
a) Worsening angina Patients taking beta blockers are cautioned not to stop taking them abruptly because angina may worsen and myocardial infarction may develop. Beta blockers do not cause the formation of blood clots, internal bleeding, or thrombocytopenia.
The patient with cardiac failure is taught to report which of the following symptoms to the physician or clinic immediately? a) Increased appetite b) Persistent cough c) Weight loss d) Ability to sleep through the night
b (Persistent cough Persistent cough may indicate an onset of left-sided heart failure. Loss of appetite should be reported immediately. Weight gain should be reported immediately. Frequent urination, causing interruption of sleep, should be reported immediately.)
The nurse is caring for a client with a diagnosis of atrial fibrillation. The onset was approximately 2 to 3 days ago. The client is scheduled for a transesophageal echocardiogram this morning. The client's spouse asks what this test is for. The best response by the nurse is which of the following? a) "This test will show the specific area causing the atrial fibrillation and what can be done to stop it." b) "This test will show any blood clots in the heart and if it is safe to do a cardioversion." c) "This test will let the doctor know if the client is at risk for hypotension." d) "This test will show if the client needs a cardiac catheterzation."
b) "This test will show any blood clots in the heart and if it is safe to do a cardioversion." When contemplating cardioversion for the client with atrial fibrillation, the absence of a thrombus in the atria can be confirmed by transesophageal echocardiogram.
Which of the following methods to induce hemostasis after sheath removal post percutaneous transluminal coronary angioplasty (PTCA) is the least effective? a) Application of a vascular closure device, such as Angioseal, VasoSeal, Duett, or Syvek patch b) Application of a sandbag to the area c) Direct manual pressure d) Application of a pneumatic compression device (eg, Fem-Stop)
b) Application of a sandbag to the area several nursing interventions frequently used as part of the standard of care, such as applying a sandbag to the sheath insertion site, have not been shown to be effective in reducing the incidence of bleeding. Application of a vascular closure device has been demonstrated to be very effective. Direct manual pressure to the sheath introduction site has been demonstrated to be effective and was the first method used to induce hemostasis post PTCA. Application of a pneumatic compression device post PTCA has been demonstrated to be effective.
A patient has had cardiac surgery and is being monitored in the intensive care unit (ICU). What complication should the nurse monitor for that is associated with an alteration in preload? a) Hypertension b) Cardiac tamponade c) Elevated central venous pressure d) Hypothermia
b) Cardiac tamponade Preload alterations occur when too little blood volume returns to the heart as a result of persistent bleeding and hypovolemia. Excessive postoperative bleeding can lead to decreased intravascular volume, hypotension, and low cardiac output. Bleeding problems are common after cardiac surgery because of the effects of cardiopulmonary bypass, trauma from the surgery, and anticoagulation. Preload can also decrease if there is a collection of fluid and blood in the pericardium (cardiac tamponade), which impedes cardiac filling. Cardiac output is also altered if too much volume returns to the heart, causing fluid overload.
The nurse is analyzing the electrocardiogram (ECG) strip of a stable patient admitted to the telemetry unit. The patient's ECG strip demonstrates PR intervals that measure 0.24 seconds. Which of the following is the nurse's most appropriate action? a) Instruct the patient to bear down as if having a bowel movement. b) Document the findings and continue to monitor the patient. c) Notify the patient's primary care provider of the findings. d) Apply oxygen via nasal cannula and obtain a 12-lead ECG.
b) Document the findings and continue to monitor the patient. The patient's ECG tracing indicates a first-degree atrioventricular (AV) block. First-degree AV block *rarely causes any hemodynamic effect*; the other blocks may result in decreased heart rate, causing a decrease in perfusion to vital organs, such as the brain, heart, kidneys, lungs, and skin. The most appropriate action by the nurse is to document the findings and continue to monitor the patient.
A client with heart failure must be monitored closely after starting diuretic therapy. The best indicator for the nurse to monitor is: a urine specific gravity. b) weight. c) vital signs. d) fluid intake and output.
b) weight.
A patient has missed 2 doses of digitalis (Digoxin). What laboratory results would indicate to the nurse that the patient is within therapeutic range?a) 4.0 mg/mLb) 0.25 mg/mLc) 2.0 mg/mLd) 3.2 mg/mL
c
A client is awaiting the availability of a heart for transplant. What option may be available to the client as a bridge to transplant? a) Implanted cardioverter-defibrillator (ICD) b) Pacemaker c) Ventricular assist device (VAD) d) Intra-aortic balloon pump (IABP)
c(Ventricularassistdevice (VAD) VADs may be used for one of three purposes:(1) a bridge to recovery, (2) a bridge to transport, or (2) destination therapy (mechanical circulatory support when there is no option for a heart transplant). An implanted cardioverter-defibrillator or pacemaker is not a bridge to transplant and will only correct the conduction disturbance and not the pumping efficiency. An IABP is a temporary, secondary mechanical circulatory pump to supplement the ineffectual contraction of the left ventricle. The IABP is intended for only a few days.)
A client is receiving captopril (Capoten) for heart failure. The nurse should notify the physician that the medication therapy is ineffective if an assessment reveals: a) postural hypotension. b) skin rash. c) peripheral edema. d) dry cough.
c(peripheral edema. Peripheral edema is a sign of fluid volume excess and worsening heart failure. A skin rash, dry cough, and postural hypotension are adverse reactions to captopril, but they don't indicate that therapy is ineffective.)
You are caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client? a) Nausea b) Hypotension c) Fever d) Fluttering
d) Fluttering Premature ventricular contractions usually cause a flip-flop sensation in the chest, sometimes described as "fluttering." Associated signs and symptoms include pallor, nervousness, sweating, and faintness. Symptoms of premature ventricular contractions are not nausea, hypotension, and fever.
A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do? a) Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. b) Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician. c) Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team. d) Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.
d) Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin. Cardiac chest pain is caused by myocardial ischemia. Therefore the nurse should administer supplemental oxygen to increase the myocardial oxygen supply, attach a cardiac monitor to help detect life-threatening arrhythmias, and take vital signs to ensure that the client isn't hypotensive before giving sublingual nitroglycerin for chest pain. Registration information may be delayed until the client is stabilized. Alerting the cardiac catheterization team or the physician before completing the initial assessment is premature.
Which condition most commonly results in coronary artery disease (CAD)? a) Renal failure b) Myocardial infarction c) Diabetes mellitus d) Atherosclerosis
d) Atherosclerosis Atherosclerosis (plaque formation), is the leading cause of CAD. Diabetes mellitus is a risk factor for CAD, but it isn't the most common cause. Myocardial infarction is a common result of CAD. Renal failure doesn't cause CAD, but the two conditions are related.
A nurse completed a physical exam for an insurance company. The nurse noted a cluster of abnormalities that she knew was considered a major risk factor for coronary artery disease. Choose that condition. a) Metabolic syndrome b) Diabetes mellitus c) Hypolipidemia d) Congestive heart failure
a) Metabolic syndrome Metabolic syndrome includes three of six conditions that are recognized as a major risk factor for CAD. Insulin resistance is part of the syndrome but the patient may not yet have diabetes.
A patient the nurse is caring for has a permanent pacemaker implanted with the identification code beginning with VVI. What does this indicate? A. Ventricular paced, ventricular sensed, inhibited B. Variable paced, ventricular sensed, inhibited C. Ventricular sensed, ventricular situated, implanted D. Variable sensed, variable paced, inhibited
A
The nurse is caring for an adult patient who has gone into ventricular fibrillation. When assisting with defibrillating the patient, what must the nurse do? A. Maintain firm contact between paddles and patient skin. B. Apply a layer of water as a conducting agent. C. Call all clear once before discharging the defibrillator. D. Ensure the defibrillator is in the sync mode.
A
The nurse is reviewing the medication administration record of a patient diagnosed with systolic HF. What medication should the nurse anticipate administering to this patient? A betaadrenergic blocker An antiplatelet aggregator A calcium channel blocker A nonsteroidal antiinflammatory drug (NSAID)
A betaadrenergic blocker***
The nursing educator is presenting a case study of an adult patient who has abnormal ventricular depolarization. This pathologic change would be most evident in what component of the ECG? A. P wave B. T wave C. QRS complex D. U wave
Ans: C Feedback:The QRS complex represents the depolarization of the ventricles and, as such, the electrical activity of that ventricle.
The nurse is caring for a patient who has had a biventricular pacemaker implanted. When planning the patients care, the nurse should recognize what goal of this intervention? A. Resynchronization B. Defibrillation C. Angioplasty D. Ablation
A. Resynchronization
A cardiac patient's resistance to left ventricular filling has caused blood to back up into the patient's circulatory system. What health problem is likely to result? Acute pulmonary edema Rightsided HF Right ventricular hypertrophy Leftsided HF
Acute pulmonary edema With increased resistance to left ventricular filling, blood backs up into the pulmonary circulation. The patient quickly develops pulmonary edema from the blood volume overload in the lungs. When the blood backs up into the pulmonary circulation, rightsided HF, leftsided HF, and right ventricular hypertrophy do not directly occur.
A patient is scheduled for catheter ablation therapy. When describing this procedure to the patients family, the nurse should address what aspect of the treatment? A. Resetting of the hearts contractility B. Destruction of specific cardiac cells C. Correction of structural cardiac abnormalities D. Clearance of partially occluded coronary arteries
Ans: B Feedback:Catheter ablation destroys specific cells that are the cause or central conduction route of atachydysrhythmia. It does not reset the hearts contractility and it does not address structural or vascular abnormalities.
During a CPR class, a participant asks about the difference between cardioversion and defibrillation. What would be the instructors 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.
Ans: B Feedback: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 patients 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 analyzing a rhythm strip. What component of the ECG corresponds to the resting state of the patients heart? A. P wave B. T wave C. U wave D. QRS complex
Ans: B Feedback:The T wave specifically represents ventricular muscle depolarization, also referred to as the resting state. Ventricular muscle depolarization does not result in the P wave, U wave, or QRS complex.
New nurses on the telemetry unit have been paired with preceptors. One new nurse asks her preceptor to explain depolarization. What would be the best answer by the preceptor?A. Depolarization is the mechanical contraction of the heart muscles. B. Depolarization is the electrical stimulation of the heart muscles. C. Depolarization is the electrical relaxation of the heart muscles. D. Depolarization is the mechanical relaxation of the heart muscles.
Ans: B Feedback:The electrical stimulation of the heart is called depolarization, and the mechanical contraction is called systole. Electrical relaxation is called repolarization, and mechanical relaxation is called diastole.
A patient calls his cardiologists office and talks to the nurse. He is concerned because he feels he is being defibrillated too often. The nurse tells the patient to come to the office to be evaluated because the nurse knows that the most frequent complication of ICD therapy is what? A. Infection B. Failure to capture C. Premature battery depletion D. Oversensing of dysrhythmias
Ans: D Feedback: Inappropriate delivery of ICD therapy, usually due to oversensing of atrial and sinus tachycardias with a rapid ventricular rate response, is the most frequent complication of ICD. Infections, failure to capture, and premature battery failure are less common
An ECG has been ordered for a newly admitted patient. What should the nurse do prior to electrode placement? A. Clean the skin with providone-iodine solution. B. Ensure that the area for electrode placement is dry. C. Apply tincture of benzoin to the electrode sites and wait for it to become tacky. D. Gently abrade the skin by rubbing the electrode sites with dry gauze or cloth.
Ans: D Feedback:An ECG is obtained by slightly abrading the skin with a clean dry gauze pad and placing electrodes on the body at specific areas. The abrading of skin will enhance signal transmission. Disinfecting the skin is unnecessary and conduction gel is used.
The triage nurse in the ED is assessing a patient with chronic HF who has presented with worsening symptoms. In reviewing the patient's medical history, what is a potential primary cause of the patient's heart failure? Endocarditis Pleural effusion Atherosclerosis Atrial septal defect
Atherosclerosis Feedback: Atherosclerosis of the coronary arteries is the primary cause of HF. Pleural effusion, endocarditis, and an atrialseptal defect are not health problems that contribute to the etiology of HF.
A patient who is at high risk for developing intracardiac thrombi has been placed on longterm anticoagulation. What aspect of the patient's health history creates a heightened risk of intracardiac thrombi? Atrial fibrillation Infective endocarditis Recurrent pneumonia Recent surgery
Atrial fibrillation
A patient with HF has met with his primary care provider and begun treatment with an angiotensinconverting enzyme (ACE) inhibitor. When the patient begins treatment, the nurse should prioritize what assessment? Blood pressure Level of consciousness (LOC) Assessment for nausea Oxygen saturation
Blood pressure**** Patients receiving ACE inhibitors are monitored for hypotension, hyperkalemia (increased potassium in the blood), and alterations in renal function.
A patient is admitted to the cardiac care unit for an electrophysiology (EP) study. What goal should guide the planning and execution of the patients care? A. Ablate the area causing the dysrhythmia. B. Freeze hypersensitive cells. C. Diagnose the dysrhythmia. D. Determine the nursing plan of care.
C. Diagnose the dysrhythmia. Feedback:A patient may undergo an EP study in which electrodes are placed inside the heart to obtain an intracardiac ECG. This is used not only to diagnose the dysrhythmia but also to determine the most effective treatment plan. However, because an EP study is invasive, it is performed in the hospital and may require that the patient be admitted.
The nurse is caring for an adult patient with HF who is prescribed digoxin. When assessing the patient for adverse effects, the nurse should assess for which of the following signs and symptoms? Confusion and bradycardia Uncontrolled diuresis and tachycardia Numbness and tingling in the extremities Chest pain and shortness of breath
Confusion and bradycardia Feedback: A key concern associated with digitalis therapy is digitalis toxicity. Symptoms include anorexia, nausea, visual disturbances, confusion, and bradycardia. The other listed signs and symptoms are not characteristic of digitalis toxicity.
The nurse is assessing a patient who is known to have rightsided HF. What assessment finding is most consistent with this patient's diagnosis? Pulmonary edema Distended neck veins Dry cough Orthopnea
Distended neck veins
The triage nurse in the ED is performing a rapid assessment of a man with complaints of severe chest pain and shortness of breath. The patient is diaphoretic, pale, and weak. When the patient collapses, what should the nurse do first? Check for a carotid pulse. Apply supplemental oxygen. Give two full breaths. Gently shake and shout, "Are you OK?"
Gently shake and shout, "Are you OK?"***
The nurse is providing patient education prior to a patient's discharge home after treatment for HF. The nurse gives the patient a home care checklist as part of the discharge teaching. What should be included on this checklist? Know how to recognize and prevent orthostatic hypotension. Weigh yourself weekly at a consistent time of day. Measure everything you eat and drink until otherwise instructed. Limit physical activity to only those tasks that are absolutely necessary.
Know how to recognize and prevent orthostatic hypotension.****
Cardiopulmonary resuscitation has been initiated on a patient who was found unresponsive. When performing chest compressions, the nurse should do which of the following? Perform at least 100 chest compressions per minute. Pause to allow a colleague to provide a breath every 10 compressions. Pause chest compressions to allow for vital signs monitoring every 4 to 5 minutes. Perform highquality chest compressions as rapidly as possible.
Perform at least 100 chest compressions per minute.***
The nurse is caring for a 68yearold patient the nurse suspects has digoxin toxicity. In addition to physical assessment, the nurse should collect what assessment datum? Skin turgor Potassium level White blood cell count Peripheral pulses
Potassium level the serum potassium level is monitored because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity may occur. Skin turgor, white cell levels, and peripheral pulses are not normally affected in cases of digitalis toxicity.
A patient in cardiogenic shock after a myocardial infarction is placed on an intra-aortic balloon pump (IABP). What does the nurse understand is the mechanism of action of the balloon pump? a) The balloon inflates at the beginning of diastole and deflates before systole to augment the pumping action of the heart. b) The balloon delivers an electrical impulse to correct dysrhythmias the patient experiences. c) The balloon keeps the vessels open so that blood will adequately deliver to the myocardium. d) The balloon will inflate at the beginning of systole and deflate before diastole to provide a long-term solution to a failing myocardium
a(The balloon inflates at the beginning of diastole and deflates before systole to augment the pumping action of the heart.
A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client's care plan, which expected outcome should a nurse include? a) "Client will verbalize the intention to stop smoking." b) "Client will verbalize an understanding of the need to call the physician if acute pain lasts more than 2 hours." c) "Client will verbalize the intention to avoid exercise." d) "Client will verbalize an understanding of the need to restrict dietary fat, fiber, and cholesterol."
a) "Client will verbalize the intention to stop smoking." A client with angina pectoris should stop smoking at once because smoking increases the blood carboxyhemoglobin level; this increase, in turn, reduces the heart's oxygen supply and may induce angina. The client must seek immediate medical attention if chest pain doesn't subside after three nitroglycerin doses taken 5 minutes apart; serious myocardial damage or even sudden death may occur if chest pain persists for 2 hours. To improve coronary circulation and promote weight management, the client should get regular daily exercise. The client should eat plenty of fiber, which may decrease serum cholesterol and triglyceride levels and minimize hypertension, in turn reducing the risk for atherosclerosis (which plays a role in angina).
A 23-year-old female client has been diagnosed with Raynaud's disease. The nurse teaches the client which of the following self-care strategies to minimize risks associated with this disease? Select all that apply. a) Avoid over-the-counter decongestants and cold remedies. b) Wear gloves to protect hands from injury when performing tasks. c) Refrain from going outdoors in cold weather. d) Limit activities that place stress on the ulnar nerve. e) Do not smoke or stop smoking.
a) Avoid over-the-counter decongestants and cold remedies. b) Wear gloves to protect hands from injury when performing tasks. e) Do not smoke or stop smoking. The nurse instructs clients with Raynaud's disease to quit smoking, avoid over-the-counter decongestants, cold remedies, and drugs for symptomatic relief of hay fever because of their vasoconstrictive qualities, protect hands and feet from injury, and wear warm socks and mittens when going outdoors in the cold weather.
Which of the following medications does the nurse anticipate administering to a client preparing for cardioversion? a) Valium b) Vasotec c) Atropine d) Lanoxin
a) Valium Prior to cardioversion, cardiac medications are held, and the client is sedated with a medication such as Valium.
The classic ECG changes that occur with an MI include all of the following except :a. an absent P wave. b. an abnormal Q wave. c. T-wave inversion. d. ST-segment elevation.
a. an absent P wave.
A goal of dilation in PTCA is to increase blood flow through the artery's lumen and achieve a residual stenosis of less than: a. 20%. b. 35%. c. 60%. d. 80%.
a20%.
The key, diagnostic indicator for myocardial infarction seen on an electrocardiogram is:________________________.
an elevated ST segment in two contiguous leads
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? a) 15 minutes b) 10 minutes c) 20 minutes d) 25 minutes
b
A nurse is assessing a client with suspected cardiac tamponade. How should the nurse assess the client for pulsus paradoxus? a) Measure the blood pressure in right arm as the client inhales slowly, then measure the blood pressure in the left arm as the client exhales slowly. b) Measure the blood pressure in either arm as the client slowly exhales and then as the client breathes normally. c) Measure blood pressure in the right arm, then in the left arm as the client slows the pace of his inhalations and exhalations. d) Measure blood pressure in either arm with the client holding his breath, then with the client breathing normally.
b(Measure the blood pressure in either arm as the client slowly exhales and then as the client breathes normally.
Jack Johnson is a 58-year-old who's been living with an internal, fixed-rate pacemaker. You're checking his readings on a cardiac monitor and notice an absence of spikes. What should you do? a) Suggest the need for a new beta-blocker to the doctor. b) Double-check the monitoring equipment. c) Nothing, there's no cause for alarm. d) Take Jack's blood pressure.
b) Double-check the monitoring equipment. One of the reasons for lack of pacemaker spikes is faulty monitoring equipment. It's important to be careful. One of the reasons for lack of pacemaker spikes is faulty monitoring equipment. Focus on the monitor.
The nurse is preparing a patient for upcoming electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia. Which of the following information should the nurse include? a) The procedure takes less time than a cardiac catheterization. b) During the procedure, the arrhythmia will be reproduced under controlled conditions. c) After the procedure, the arrhythmia will not recur. d) The procedure will occur in the operating room under general anesthesia.
b) During the procedure, the arrhythmia will be reproduced under controlled conditions. During EP studies, the patient is awake and may experience symptoms related to the arrhythmia. EP studies do not always include ablation of the arrhythmia.
A patient diagnosed with a myocardial infarction (MI) has begun an active rehabilitation program. The nurse recognizes an overall goal of rehabilitation for a patient who has had an MI includes which of the following? a) Returning the patient to work and a preillness lifestyle b) Improvement of the quality of life c) Prevention of another cardiac event d) Limiting the effects and progression of atherosclerosis
b) Improvement of the quality of life Overall, cardiac rehabilitation is a complete program dedicated to extending and improving quality of life.
Undersensing occurs as a pacemaker malfunctions as a result of which of the following events? a) Total absence of the pacing spike b) Pacing spike occurs at the preset level despite the patient's intrinsic rhythm c) Loss of pacing artifact d) The complex does not follow the pacing spike
b) Pacing spike occurs at the preset level despite the patient's intrinsic rhythm Undersensing means that the pacing spike occurs at preset interval despite the patient's intrinsic rhythm. Loss of capture occurs when a complex does not follow a pacing spike. Loss of pacing is total absence of the pacing spike. Oversensing occurs when there is a loss of pacing artifact.
An antidote for propranolol hydrochloride (a beta-adrenergic blocker) that is used to treat bradycardia is: a. digoxin. b. atropine. c. protamine sulfate. d. sodium nitroprusside.
b. atropine.
The most common heart disease for adults in the United States is: a. angina pectoris. b. coronary artery disease. c. myocardial infarction. d. valvular heart disease.
b. coronary artery disease
Myocardial cell damage can be reflected by high levels of cardiac enzymes. The cardiac-specificisoenzyme is: a. alkaline phosphatase. b. creatine kinase (CK-MB). c. myoglobin. d. troponin.
b. creatine kinase (CK-MB).
The most common nursing diagnosis for patients awaiting cardiac surgery is: a. activity intolerance. b. fear related to the surgical procedure. c. decreased cardiac output. d. anginal pain.
b. fear related to the surgical procedure
The most common site of myocardial infarction is the: a. left atrium. b. left ventricle. c. right atrium. d. right ventricle.
b. left ventricle.
Lumen narrowing with atherosclerosis is caused by: a. atheroma formation on the intima. b. scarred endothelium. c. thrombus formation. d. all of the above.
b. scarred endothelium.
The nurse expects a postoperative PTCA patient to be discharged: a. the same day as surgery. b. within 24 hours of the procedure. c. 3 days later. d. after 1 week.
b. within 24 hours of the procedure.
A client with chest pain arrives in the emergency department and receives nitroglycerin, morphine (Duramorph), oxygen, and aspirin. The physician diagnoses acute coronary syndrome. When the client arrives on the unit, his vital signs are stable and he has no complaints of pain. The nurse reviews the physician's orders. In addition to the medications already given, which medication does the nurse expect the physician to order? a) Nitroprusside (Nipride) b) Furosemide (Lasix) c) Carvedilol (Coreg) d) Digoxin (Lanoxin)
c) Carvedilol (Coreg) A client with suspected myocardial infarction should receive aspirin, nitroglycerin, morphine, and a beta-adrenergic blocker such as carvedilol. Digoxin treats arrhythmias; there is no indication that the client is having arrhythmias. Furosemide is used to treat signs of heart failure, which isn't indicated at this point. Nitroprusside increases blood pressure. This client has stable vital signs and isn't hypotensive.
A client is recovering from coronary artery bypass graft (CABG) surgery. The nurse knows that for several weeks after this procedure, the client is at risk for certain conditions. During discharge preparation, the nurse should advise the client and his family to expect which common symptom that typically resolves spontaneously? a) Memory lapses b) Ankle edema c) Depression d) Dizziness
c) Depression For the first few weeks after CABG surgery, clients commonly experience depression, fatigue, incisional chest discomfort, dyspnea, and anorexia. Depression typically resolves without medical intervention. However, the nurse should advise family members that symptoms of depression don't always resolve on their own. They should make sure they recognize worsening symptoms of depression and know when to seek care. Ankle edema seldom follows CABG surgery and may indicate right-sided heart failure. Because this condition is a sign of cardiac dysfunction, the client should report ankle edema at once. Memory lapses reflect neurologic rather than cardiac dysfunction. Dizziness may result from decreased cardiac output, an abnormal condition following CABG surgery. This symptom warrants immediate physician notification.
Which of the following is the treatment of choice for ventricular fibrillation? a) Implanted defibrillator b) Pacemaker c) Immediate bystander CPR d) Atropine
c) Immediate bystander CPR The treatment of choice for v-fib is immediate bystander cardiopulmonary resuscitation (CPR), defibrillation as soon as possible, and activation of emergency services.
A patient presents to the ED complaining of anxiety and chest pain after shoveling heavy snow that morning. The patient says that he has not taken nitroglycerin for months but did take three nitroglycerin tablets and although the pain is less, "They did not work all that well. " The patient shows the nurse the nitroglycerin bottle and the prescription was filled 12 months ago. The nurse anticipates which of the following physician orders? a) Serum electrolytes b) Ativan 1 mg orally c) Nitroglycerin SL d) Chest x-ray
c) Nitroglycerin SL Nitroglycerin is volatile and is inactivated by heat, moisture, air, light, and time. Nitroglycerin should be renewed every 6 months to ensure full potency. The client's tablets were expired and the nurse should anticipate administering nitroglycerin to assess if the chest pain subsides. The other choices may be ordered at a later time, but the priority is to relieve the patient's chest pain.
When the nurse observes an electrocardiogram (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? a) Ventricular tachycardia b) Ventricular bigeminy c) Premature ventricular contraction (PVC) d) Ventricular fibrillation
c) Premature ventricular contraction (PVC) A PVC is an impulse that starts in a ventricle before the next normal sinus impulse. Ventricular bigeminy is a rhythm in which every other complex is a PVC. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute. Ventricular fibrillation is a rapid but disorganized ventricular rhythm that causes ineffective quivering of the ventricles.
When no atrial impulse is conducted through the AV node into the ventricles, the patient is said to be experiencing which type of AV block? a) First degree b) Second degree, type II c) Third degree d) Second degree, type I
c) Third degree
Which of the following findings is not a significant risk factor for heart disease? a. Cholesterol, 280 mg/dL b. LDL, 160 mg/dL c. High-density lipoproteins (HDL), 80 mg/dL d. A ratio of low-density lipoproteins (LDL) toHDL, 4.5 to 1.0
c. High-density lipoproteins (HDL), 80 mg/dL
A candidate for percutaneous transluminal coronary angioplasty (PTCA) is a patient with coronary artery disease who: a. has compromised left ventricular function. b. has had angina longer than 3 years. c. has at least 70% occlusion of a majorcoronary artery. d. has questionable left ventricular function.
c. has at least 70% occlusion of a majorcoronary artery.
Which of the following symptoms should the nurse expect to find as an early symptom of chronic heart failure? a) Pedal edema b) Nocturia c) Irregular pulse d) Fatigue
d(Fatigue)
Which medication should a nurse have on hand when removing a sheath after cardiac catheterization? a) Heparin b) Adenosine (Adenocard) c) Protamine sulfate d) Atropine
d) Atropine Removing the sheath after cardiac catheterization may cause a vasovagal response, including bradycardia. The nurse should have atropine on hand to increase the client's heart rate if this occurs. Heparin thins the blood; clients should stop taking it before the sheath removal. Protamine sulfate is an antidote to heparin, but the nurse shouldn't administer it during sheath removal. Adenosine treats tachyarrhythmias.
A patient has had several episodes of recurrent tachydysrhythmias over the last 5 months and medication therapy has not been effective. What procedure should the nurse prepare the patient for? a) Insertion of an ICD b) Maze procedure c) Insertion of a permanent pacemaker d) Catheter ablation therapy
d) Catheter ablation therapy Catheter ablation destroys specific cells that are the cause or central conduction route of a tachydysrhythmia. It is performed with or after an electrophysiology study. Usual indications for ablation are atrioventricular nodal reentry tachycardia, a recurrent atrial dysrhythmia (especially atrial fibrillation), or ventricular tachycardia unresponsive to previous therapy (or for which the therapy produced significant side effects).
The nurse is aware that a client who has been diagnosed with Prinzmetal's angina will present with which of the following symptoms? a) Radiating chest pain that lasts 15 minutes or less b) Chest pain of increased frequency, severity, and duration c) Prolonged chest pain that accompanies exercise d) Chest pain that occurs at rest and usually in the middle of the night
d) Chest pain that occurs at rest and usually in the middle of the night A client with Prinzmetal's angina will complain of chest pain that occurs at rest, usually between 12 and 8 AM, is sporadic over 3-6 months, and diminishes over time. Client with stable angina generally experience chest pain that lasts 15 minutes or less and may radiate. Clients with Cardiac Syndrome X experience prolonged chest pain that accompanies exercise and is not always relieved by medication. Client with unstable angina experience chest pain of increased frequency, severity, and duration that is poorly relieved by rest or oral nitrates.
Which of the following medications is given to patients diagnosed with angina and is allergic to aspirin? a) Diltiazem (Cardizem) b) Felodipine (Plendil) c) Amlodipine (Norvasc) d) Clopidogrel (Plavix)
d) Clopidogrel (Plavix) Plavix or Ticlid is given to patients who are allergic to aspirin or given in addition to aspirin to patients at high risk for MI. Norvasc, Cardizem, and Plendil are calcium channel blockers.
After 2-hour onset of acute chest pain, the client is brought to the emergency department for evaluation. Elevation of which diagnostic findings would the nurse identify as suggestive of an acute myocardial infarction at this time? a) WBC (white blood cell) count b) Troponin I c) C-reactive protein d) Myoglobin
d) Myoglobin Myoglobin is a biomarker that rises in *2 to 3 hours* after heart damage. Troponin is the gold standard for determining heart damage, but troponin I levels due not rise until 4 to 6 hours after MI. WBCs and C-reactive protein levels will rise but not until about day 3.
The nurse is analyzing the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which of the following findings indicate the need for follow-up? a) ST segment that is isoelectric in appearance b) PR interval that is 0.18 seconds long c) QRS complex that is 0.10 seconds long d) QT interval that is 0. 46 seconds long
d) QT interval that is 0. 46 seconds long The QT interval that is 0.46 seconds long needs to be investigated. The QT interval is usually 0.32 to 0.40 seconds in duration if the heart rate is 65 to 95 bpm. If the QT interval becomes prolonged, the patient may be at risk for a lethal ventricular dysrhythmia called torsades de pointes. The other findings are normal.
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? a) SA node, AV node, bundle of His, the Purkinje fibers, and the right and left bundle branches b) SA node, AV node, right and left bundle branches, bundle of His, and the Purkinje fibers c) AV node, SA node, bundle of His, right and left bundle branches, and the Purkinje fibers d) Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers
d) 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.
Hypertension is repeated blood pressure measurements exceeding: a. 110/80 mm Hg. b. 120/80 mm Hg .c. 130/90 mm Hg. d. 140/90 mm Hg.
d. 140/90 mm Hg.
A candidate for coronary artery bypass grafting (CABG) must meet which of the following criteria? a. A blockage that cannot be treated by PTCA b. Greater than 60% blockage in the left maincoronary artery. c. Unstable angina. d. All of the above.
d. All of the above
A nurse in the CCU is caring for a patient with HF who has developed an intracardiac thrombus. This creates a high risk for what sequela? Stroke Myocardial infarction (MI) Hemorrhage Peripheral edema
stroke Feedback: Intracardiac thrombi can become lodged in the cerebral vasculature, causing stroke. There is no direct risk of MI, hemorrhage, or peripheral edema.
The nurse is caring for a patient who is in the recovery room following the implantation of an ICD. The patient has developed ventricular tachycardia (VT). What should the nurse assess and document? A. ECG to compare time of onset of VT and onset of devices shock B. ECG so physician can see what type of dysrhythmia the patient has C. Patients level of consciousness (LOC) at the time of the dysrhythmia D. Patients activity at time of dysrhythmia
Ans: A Feedback:If the patient has an ICD implanted and develops VT or ventricular fibrillation, the ECG should be recorded to note the time between the onset of the dysrhythmia and the onset of the devices shock or antitachycardia pacing. This is a priority over LOC or activity at the time of onset.
A patient who is a candidate for an implantable cardioverter defibrillator (ICD) asks the nurse about the purpose of this device. What would be the nurses 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
Ans: A Feedback: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.
The nurse caring for a patient whose sudden onset of sinus bradycardia is not responding adequately to atropine. What might be the treatment of choice for this patient? A. Implanted pacemaker B. Trancutaneous pacemaker C. ICD D. Asynchronous defibrillator
Ans: B \ Feedback:If a patient suddenly develops a bradycardia, is symptomatic but has a pulse, and is unresponsive to atropine, emergency pacing may be started with transcutaneous pacing, which most defibrillators are now equipped to perform. An implanted pacemaker is not a time-appropriate option. An asynchronous defibrillator or ICD would not provide relief.
During a patients care conference, the team is discussing whether the patient is a candidate for cardiac conduction surgery. What would be the most important criterion for a patient to have this surgery? A. Angina pectoris not responsive to other treatments B. Decreased activity tolerance related to decreased cardiac output C. Atrial and ventricular tachycardias not responsive to other treatments D. Ventricular fibrillation not responsive to other treatments
Ans: C Feedback:Cardiac conduction surgery is considered in patients who do not respond to medications and antitachycardia pacing. Angina, reduced activity tolerance, and ventricular fibrillation are not criteria.
An adult patient with third-degree AV block is admitted to the cardiac care unit and placed on continuous cardiac monitoring. What rhythm characteristic will the ECG most likely show? A. PP interval and RR interval are irregular. B. PP interval is equal to RR interval. C. Fewer QRS complexes than P waves D. PR interval is constant.
Ans: C Feedback:In third-degree AV block, no atrial impulse is conducted through the AV node into the ventricles. As a result, there are impulses stimulating the atria and impulses stimulating the ventricles. Therefore, there are more P waves than QRS complexes due to the difference in the natural pacemaker (nodes) rates of the heart. The other listed ECG changes are not consistent with this diagnosis.
The nurse is caring for a patient on telemetry. The patients ECG shows a shortened PR interval, slurring of the initial QRS deflection, and prolonged QRS duration. What does this ECG show? A. Sinus bradycardia B. Myocardial infarction C. Lupus-like syndrome D. Wolf-Parkinson-White (WPW) syndrome
Ans: D Feedback:In WPW syndrome there is a shortened PR interval, slurring (called a delta wave) of the initial QRS deflection, and prolonged QRS duration. These characteristics are not typical of the other listed cardiac anomalies.
A group of nurses are participating in orientation to a telemetry unit. What should the staff educator tell this class about ST segments? A. They are the part of an ECG that reflects systole. B. They are the part of an ECG used to calculate ventricular rate and rhythm. C. They are the part of an ECG that reflects the time from ventricular depolarization through repolarization. D. They are the part of an ECG that represents early ventricular repolarization.
Ans: D Feedback:ST segment is the part of an ECG that reflects the end of the QRS complex to the beginning of the T wave. The part of an ECG that reflects repolarization of the ventricles is the T wave. The part of an ECG used to calculate ventricular rate and rhythm is the RR interval. The part of an ECG that reflects the time from ventricular depolarization through repolarization is the QT interval.
A patient with a diagnosis of HF is started on a betablocker. What is the nurse's priority role during gradual increases in the patient's dose? Educating the patient that symptom relief may not occur for several weeks Stressing that symptom relief may take up to 4 months to occur Making adjustments to each day's dose based on the blood pressure trends Educating the patient about the potential changes in LOC that may result from the drug
Educating the patient that symptom relief may not occur for several weeks***
The nurse is performing an initial assessment of a client diagnosed with HF. The nurse also assesses the patient's sensorium and LOC. Why is the assessment of the patient's sensorium and LOC important in patients with HF? HF ultimately affects oxygen transportation to the brain. Patients with HF are susceptible to overstimulation of the sympathetic nervous system. Decreased LOC causes an exacerbation of the signs and symptoms of HF. The most significant adverse effect of medications used for HF treatment is altered LOC.
HF ultimately affects oxygen transportation to the brain.****
Which assessment would be most appropriate for a patient who is receiving a loop diuretic for HF? Monitor liver function studies Monitor for hypotension Assess the patient's vitamin D intake Assess the patient for hyperkalemia
Monitor for hypotension Diuretic therapy increases urine output and decreases blood volume, which places the patient at risk of hypotension. Patients are at risk of losing potassium with loop diuretic therapy and need to continue with potassium in their diet; hypokalemia is a consequent risk. Liver function is rarely compromised by diuretic therapy and vitamin D intake is not relevant.
The nurse's comprehensive assessment of a patient who has HF includes evaluation of the patient's hepatojugular reflux. What action should the nurse perform during this assessment? Elevate the patient's head to 90 degrees. Press the right upper abdomen. Press above the patient's symphysis pubis. Lay the patient flat in bed.
Press the right upper abdomen. Feedback: Hepatojugular reflux, a sign of rightsided heart failure, is assessed with the head of the bed at a 45degree angle. As the right upper abdomen (the area over the liver) is compressed for 30 to 40 seconds, the nurse observes the internal jugular vein. If the internal jugular vein becomes distended, a patient has positive hepatojugular reflux.
Heparin therapy is usually considered therapeutic when the patient's activated partial thromboplastin time (aPTT) is how many times normal? a) 2 to 2.5 b) .5 to 1 c) 2.5 to 3 d) .25 to .75
a) 2 to 2.5 The amount of heparin administered is based on aPTT results, which should be obtained in follow-up to any alteration of dosage. The patient's aPTT value would have to be greater than .5 to 1 times normal to be considered therapeutic. An aPTT value that is 2.5 to 3 times normal would be too high to be considered therapeutic. The patient's aPTT value would have to be greater than .25 to .75 times normal to be considered therapeutic.
Understanding atherosclerosis, the nurse identifies which of the following to be both a risk factor for the development of the disorder and an outcome? a) Hypertension b) Hyperlipidemia c) Obesity d) Glucose intolerance
a) Hypertension Increases in diastolic and systolic blood pressure are associated with an increased incidence of atherosclerosis, often an inherited factor. Elevation of blood pressure results when the vessels cannot relax and impairs the ability of the artery to dilate. Hyperlipidemia, diabetes, and obesity are all risk factors for atherosclerosis but do not result from the disorder.
A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continuous hiccups as the patient states, "I thought this was normal." What does the nurse understand is occurring with this patient? a) Lead wire dislodgement b) Faulty generator c) Sensitivity is too low d) Fracture of the lead wire
a) Lead wire dislodgement Phrenic nerve, diaphragmatic (hiccuping may be a sign), or skeletal muscle stimulation may occur if the lead is dislocated or if the delivered energy (mA) is set high. The occurrence of this complication is avoided by testing during device implantation.
Upon discharge from the hospital, patients diagnosed with a myocardial infarction (MI) must be placed on all of the following medications except: a) Morphine IV b) Angiotensin-converting enzyme (ACE) inhibitor c) Aspirin d) Statin
a) Morphine IV Upon patient discharge, there needs to be documentation that the patient was discharged on a statin, an ACE or angiotensin receptor blocking agent (ARB), and aspirin. Morphine IV is used for these patients to reduce pain and anxiety. The patient would not be discharged with IV morphine.
Following a percutaneous transluminal coronary angioplasty, a client is monitored in the postprocedure unit. The client's heparin infusion was stopped 2 hours earlier. There is no evidence of bleeding or hematoma at the insertion site, and the pressure device is removed. The nurse should plan to remove the femoral sheath when the partial thromboplastin time (PTT) is: a) 125 seconds or less. b) 100 seconds or less. c) 50 seconds or less. d) 75 seconds or less.
c) 50 seconds or less. Heparin causes an elevation of the PTT and, thereby, increases the risk for bleeding. With a large cannulation such as a sheath used for angioplasty, the PTT should be 50 seconds or less before the sheath is removed. Removing the sheath before the PTT drops below 50 seconds can cause bleeding at the insertion site. The other PTT results are incorrect for determining when to remove the sheath.
Shortly after being admitted to the coronary care unit with an acute myocardial infarction (MI), a client reports midsternal chest pain radiating down his left arm. The nurse notes that the client is restless and slightly diaphoretic, and measures a temperature of 99.6° F (37.6° C); a heart rate of 102 beats/minute; regular, slightly labored respirations at 26 breaths/minute; and a blood pressure of 150/90 mm Hg. Which nursing diagnosis takes highest priority? a) Decreased cardiac output b) Risk for imbalanced body temperature c) Acute pain d) Anxiety
c) Acute pain The nursing diagnosis of Acute pain takes highest priority because it increases the client's pulse and blood pressure. During the acute phase of an MI, low-grade fever is an expected result of the body's response to myocardial tissue necrosis. This makes Risk for imbalanced body temperature an incorrect answer. The client's blood pressure and heart rate don't suggest a nursing diagnosis of Decreased cardiac output. Anxiety could be an appropriate nursing diagnosis, but addressing Acute pain (the priority concern) may alleviate the client's anxiety.
changes of aging predispose clients to vascular occlusive disorders. What would you name as the most common cause of peripheral arterial problems in the older adult? a) Raynaud's disease b) Coronary thrombosis c) Atherosclerosis d) Arteriosclerosis
c) Atherosclerosis Atherosclerosis is the most common cause of peripheral arterial problems in the older adult. The disease correlates with the aging process. The other choices may occur at any age.
A patient with mitral valve stenosis and coronary artery disease (CAD) is in the telemetry unit with pneumonia. The nurse assesses a 6-second rhythm strip and determines that the ventricular rhythm is highly irregular at 88, with no discernible P waves. What does the nurse determine this rhythm to be? a) Sinus tachycardia b) Ventricular flutter c) Atrial flutter d) Nonparoxysmal junctional tachycardia
c) Atrial flutter Atrial flutter occurs because of a conduction defect in the atrium and causes a rapid, regular atrial rate, usually between 250 and 400 bpm and results in P waves that are saw-toothed. Ventricular rhythm may be irregular, and P waves may be absent. Ventricular rate usually ranges between 75 and 150 bpm.
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) Stay at least 2' away from microwave ovens. b) Never engage in activities that require vigorous arm and shoulder movement. c) Avoid undergoing magnetic resonance imaging (MRI). d) Avoid going through airport metal detectors.
c) Avoid undergoing magnetic resonance imaging (MRI). A client with a pacemaker should avoid undergoing an MRI because the magnet could disrupt pacemaker function and cause injury to the client. Disruption is less likely to occur with newer microwave ovens; nonetheless, the client should stay at least 5' away from microwaves, not 2'. The client must avoid vigorous arm and shoulder movement only for the first 6 weeks after pacemaker implantation. Airport metal detectors don't harm pacemakers; however, the client should notify airport security guards that he has a pacemaker because its metal casing and programming magnet could trigger the metal detector.
Creatine kinase-MB isoenzyme (CK-MB) can increase as a result of: a) skeletal muscle damage due to a recent fall .b) I.M. injection. c) myocardial necrosis. d) cerebral bleeding.
c) myocardial necrosis. An increase in CK-MB is related to myocardial necrosis. An increase in total CK might occur for several reasons, including brain injury, such as cerebral bleeding; skeletal muscle damage, which can result from I.M. injections or falls; muscular or neuromuscular disease; vigorous exercise; trauma; or surgery.
In providing nursing management to a client post-varicose vein surgery, the nurse would include which of the following teaching measures? Select all that apply. a) Cool compresses b) Take warm showers in the morning. c) Stand rather than sit. d) Elastic stockings e) Exercise f) Lower the extremities.
d) Elastic stockings e) Exercise Movement/exercise and use of elastic stocking aid in venous return. Cool compresses can cause vasoconstriction, which can diminish arterial blood flow. Elevation of legs can be helpful in aiding venous return. Standing or sitting for prolonged periods of time should be avoided. Showers in the morning can dilate blood vessels and contribute to venous congestion and edema.
Which heart rhythm occurs when the atrial and ventricular rhythms are both regular, but independent of each other? a) Second-degree heart block b) Asystole c) First-degree AV block d) Third-degree atrioventricular (AV) heart block
d) Third-degree atrioventricular (AV) heart block In third-degree AV heart block there is no relationship or synchrony between the atrial and ventricular contraction. Each is beating at its own inherent rate and is independent of each other, thus the cardiac output is affected. Second-degree AV block occurs when only some of the atrial impulses are conducted through the AV node into the ventricles. First-degree AV block occurs when atrial conduction is delayed through the AV node, resulting in a prolonged PR interval. During asystole, there is no electrical activity.
