PrepU: Assessment of Cardiovascular Function

You are doing an admission assessment on a client who is having outpatient testing done for cardiac problems. What should you ask this client during your assessment?

"Have you had any episodes of dizziness or fainting?"

A BNP level greater than ___ pg/ml is commonly associated with mild heart failure.

51 pg/ml

What is the normal serum calcium level?

8.9-10.3

The nurse is assessing a patient who complains of feeling "light-headed." When obtaining orthostatic vital signs, what does the nurse determine is a significant finding?

A heart rate of more than 20 bpm above the resting rate

The nurse is assessing a patient who complains of feeling "light-headed." When obtaining orthostatic vital signs, what does the nurse determine is a significant finding?

A heart rate of more than 20bpm above the resting rate

A nurse assessing a client who underwent cardiac catheterization finds the client lying flat on the bed. His temperature is 99.8° F (37.7° C). His blood pressure is 104/68 mm Hg. His pulse rate is 76 beats/minute. She detects weak pulses in the leg distal to the puncture site. Skin on the leg is cool to the touch. The puncture site is dry, but swollen. What is the client most likely developing?

A hematoma at the puncture site

What is BNP?

A neurohormone that responds to volume overload in the heart by acting as a diuretic and vasodilator

You are doing an admission assessment on a client who is having outpatient testing done for cardiac problems. What should you ask this client during your assessment? A) "Have you had any episodes of dizziness or fainting?" B) "Have you had any episodes when you are to nauseous?" C) "Have you had any episodes of mottling in your hands?" D) "Have you had any episodes of pain radiating into your lower extremities?"

A) "Have you had any episodes of dizziness or fainting?"

The nurse is taking a health history from a client admitted with the medical diagnosis of cardiovascular disease (CVD). Identify which of the following symptoms indicate CVD: A) Chest pain, weight gain, fatigue B) Petechiae, ascites, constipation C) Fatigue, ecchymosis, confusion D) Dizziness, rash, extra-ocular eye movements

A) Chest pain, weight gain, fatigue

Decreased pulse pressure reflects which of the following? A) Reduced stroke volume B) Reduced distensibility of the arteries C) Tachycardia D) Elevated stroke volume

A) Reduced stroke volume

Which of the following would be a factor that may decrease myocardial contractility? A) sympathetic activity b) Administration of digoxin (Lanoxin) c) Acidosis d)Alkalosis

Acidosis

What category of medication is Methylprednisolone (Solu-Medrol)?

Anti-histamine

Where is the pulmonic area located?

At the second IC space to the left of the sternum

Where is the aortic area located?

At the second IC space to the right of the sternum

A patient has undergone a cardiac catheterization. He is to be discharged today. What information should the nurse emphasize during discharge teaching?

Avoid heavy lifting for the next 24 hours

The nurse is reviewing the morning laboratory test results for a client with cardiac problems. Which of the following would the nurse regard as a priority to report to the physician? A) Ca++ 9 mg/dL B) K+ 3.1 mEq/L C) Mg++ 2 mE/L D) Na+ 140 mEq/L

B) K+ 3.1 mEq/L

A nurse is checking laboratory values on a client who has crackles in the lower lobes, 2+ pitting edema, and dyspnea with minimal exertion. Which laboratory value does the nurse expect to be abnormal?

B-type natriuretic peptide (BNP)

What neurohormone is released from the ventricles when the ventricles experience increased pressure and stretch, such as in heart failure?

BNP

The nurse is caring for a client with an elevated blood pressure and no previous history of hypertension. At 0900, the blood pressure was 158/90 mm Hg. At 0930, the blood pressure is 142/82 mm Hg. The nurse is most correct when relating the fall in blood pressure to which structure?

Baroreceptors

Where is the epigastric area located?

Below the xiphoid process

Erectile dysfunction may be a side effect of what heart medication

Beta blockers

A nurse is preparing a client for a scheduled Adenocard (adenosine) stress test. Which of the following statements by the client indicates a need for further teaching?: A) "The effects of this medication will wear off quickly." B) "I may feel some flushing or nausea with this medication." C) "My wife is bringing me a cup of coffee to drink before the test." D) "The medication will have an effect on my heart similar to exercise."

C) "My wife is bringing me a cup of coffee to drink before the test."

A client is seen in the emergency department and reports left arm pain, fatigue, palpitations, and shortness of breath. Which of the following conditions would the nurse suspect? A) Diabetes insipidus B) Renal failure C) Acute coronary syndrome D) Diabetes mellitus

C) Acute coronary syndrome

The nurse is assessing the client newly prescribed Lasix 20mg daily for 3+ pitting edema. To evaluate the effectiveness of diuretic therapy, which of the following would be documented?: A) Weight B) Urine output C) Edema D) Blood pressure

C) Edema

The nurse is caring for a patient with an intra-arterial BP monitoring device. The nurse recognizes the most preventable complication associated with hemodynamic monitoring includes which of the following?

Catheter related bloodstream infections (CRBSI)

A nurse assessing a client who underwent cardiac catheterization finds the client lying flat on the bed. His temperature is 99.8° F (37.7° C). His blood pressure is 104/68 mm Hg. His pulse rate is 76 beats/minute. She detects weak pulses in the leg distal to the puncture site. Skin on the leg is cool to the touch. The puncture site is dry, but swollen. What is the most appropriate action for the nurse to take?

Contact the physician and report her findings

The ability of the cardiac muscle to shorten in response to an electrical impulse is termed which of the following?

Contractility

CRP is used to help predict the risk of

Coronary artery disease

The nurse is reviewing the results of the patient's echocardiogram and observes that the ejection fraction is 35%. The nurse anticipates that the patient will receive treatment for what condition?

Heart failure

The nurse is caring for an elderly client with left-sided heart failure. When auscultating lung sounds, which adventitious sound is expected?

Crackles

A 52-year-old female patient is going through menopause and asks the nurse about estrogen replacement for its cardioprotective benefits. What is the best response by the nurse?

Current evidence indicates that estrogen is ineffective as a cardioprotectant and is actually potentially harmful and is no longer a recommended therapy

A student nurse is to perform a cardiac assessment for a client and asks the instructor why the aortic valve closure is best heard on the right side of the sternum. The best response of the nurse is which of the following? A) "The aortic valve is located near the apex of the heart, which is on the right side." B) "The aortic valve is located on the right side of the heart." C) "The aortic valve is located near the base of the heart on the right side." D) "The aortic arch causes the closure of the aortic valve to be heard best on the right side of the sternum."

D) "The aortic arch causes the closure of the aortic valve to be heard best on the right side of the sternum."

You are caring for a client with a damaged tricuspid valve. You know that the tricuspid valve is held in place by which of the following? A) Semilunar tendineae B) Atrioventricular tendons C) Papillary tendons D) Chordae tendineae

D) Chordae tendineae

The nurse is preparing to apply ECG electrodes to a male patient who requires continuous cardiac monitoring. Which of the following should the nurse complete to optimize skin adherence and conduction of the heart's electrical current?: A)Clean the patient's chest with alcohol prior to application of the electrodes. B)Apply baby powder to the patient's chest prior to placing the electrodes. C) Once the electrodes are applied, change them every 72 hours. D) Clip the patient's chest hair prior to applying the electrodes.

D) Clip the patient's chest hair prior to applying the electrodes

The clinic nurse caring for a client with a cardiovascular disorder is performing an assessment of the client's pulse. Which of the following steps is involved in determining the pulse deficit? A) Count the radial pulse for 20 to 25 seconds. B) Calculate the palpated volume. C) Calculate the pauses between pulsations. D) Count the heart rate at the apex

D) Count the heart rate at the apex

The nurse is administering a beta blocker to a patient in order to decrease automaticity. Which medication will the nurse administer? A) Cardizem B) Cordarone C) Rythmol D) Lopressor

D) Lopressor

The client is admitted for a scheduled cardiac catheterization. On the morning of the procedure, while assessing the client's morning laboratory values, the nurse notes a blood urea nitrogen (BUN) of 34 mg/dL and a creatinine of 4.2 mg/dL. The nurse makes it a priority to notify the physician for which of the following reasons? A) The client is over-hydrated, which puts him at risk for heart failure during the procedure. B) The client is at risk for bleeding. C) These values show a risk for dysrhythmias. D)The client is at risk for renal failure due to the contrast agent that will be given during the procedure.

D)The client is at risk for renal failure due to the contrast agent that will be given during the procedure.

A patient has been diagnosed with congestive heart failure (CHF). The physician has ordered a medication to enhance contractility. The nurse would expect which medication to be ordered for the patient?

Digoxin (Lanoxin)

A 97-year-old client with a history of atrial fibrillation is being admitted to the assisted living center where you practice nursing. In your initial assessment, you measure his apical pulse and compare it to his peripheral pulse. The difference between the two is known as what?

Pulse deficit

When caring for a client with dysfunction in the conduction system, at which period would the nurse note that cells are resistant to stimulation?

During the refractory period

The client with a diagnosis of heart failure reports frequently awakening during the night with the need to urinate. The nurse offers what explanation?

Edema is collected in dependent extremities during the day; at night when the client lays down, it is reabsorbed into the circulation and excreted by the kidneys.

The area of the heart that is located at the third intercostal (IC) space to the left of the sternum is which of the following?

Erb's point

The higher the BNP the...

Increased the severity of heart failure

The nurse is caring for a patient prescribed warfarin (Coumadin) orally. The nurse reviews the patient's prothrombin time (PT) level to evaluate the effectiveness of the medication. The nurse should also evaluate which of the following laboratory values?

Internalized normalized ratio (INR)

Within the physiology of the heart, each chamber has a particular role in maintaining cellular oxygenation. Which chamber of the heart is responsible for pumping blood to all the cells and tissues of the body?

Left ventricle

After a physical examination, the provider diagnosed a patient with a grade 4 heart murmur. During assessment, the nurse expects to hear a murmur that is:

Loud and may be associated with a thrill sound similar to a purring cat

When preparing a patient for a cardiac catheterization, the patient states that she has allergies to seafood. Which of the following medications may give to her prior to the procedure?

Methylprednisolone (Solu-Medrol)

A patient's heart rate is observed to be 140 bpm on the monitor. The nurse knows that the patient is at risk for what complication?

Myocardial ischemia

What is a common urinary problem in people with heart failure?

Nocturia

The nurse is providing discharge instructions to a client with unstable angina. The client is ordered Nitrostat 1/150 every 5 minutes as needed for angina. Which side effect, emphasized by the nurse, is common especially with the increased dosage?

Orthostatic hypotension

You are working on a telemetry unit. Your client was admitted with a cardiac event and is now on a cardiac monitor. You know a cardiac monitor reveals the heart's electrical but not its mechanical activity. How would you assess the mechanical activity of the client's heart?

Palpate a peripheral pulse

Which of the following nursing interventions is most appropriate when caring for a client with a nursing diagnosis of risk for injury related to side effects of medication (enoxaparin [Lovenox])?

Report any incidence of bloody urine, stool, or both

It is important for a nurse to understand cardiac hemodynamics. For blood to flow from the right ventricle to the pulmonary artery, what must occur?

Right ventricular pressure must be higher than pulmonary arterial pressure.

The nurse is assessing heart sounds in a patient with heart failure. An abnormal heart sound is detected early in diastole. How would the nurse document this?

S3

You are evaluating the expected outcomes on a client who is recovering from a cardiac catheterization. What is an expected outcome that you would evaluate?

The client and family understands the discharge instructions

A patient tells the nurse, "I was straining to have a bowel movement and felt like I was going to faint. I took my pulse and it was so slow." What does the nurse understand occurred with this patient?

The patient had a vagal response

The nurse in a cardiac clinic is taking vital signs of a 58-year-old man who is 3 months status post myocardial infarction (MI). While the physician is seeing the client, the client's spouse approaches the nurse and asks about sexual activity. "We are too afraid he will have another heart attack, so we just don't have sex anymore." The nurse's best response is which of the following?

The physiologic demands are greatest during orgasm and are equivalent to walking 3-4 mph on a treadmill

The patient has a heart rate of 72 bpm with a regular rhythm. Where does the nurse determine the impulse arises from?

The sinoatrial node

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

Troponin T and I

A nurse is caring for a dying client following myocardial infarction. The client is experiencing apnea with a falling blood pressure of 60 per palpation. Which documentation of pulse quality does the nurse anticipate?

Weak pulse

When assessing a patient with left-sided heart failure, what would be noted on auscultation of lungs?

Wheezes with wet-lung sounds

When in BNP released?

When the ventricles experience increased pressure and stretch, such as in heart failure

A patient is admitted to a hospital to confirm a diagnosis of postural hypotension. The nurse assesses the patient's blood pressure every 4 hours. Which of the following is an indicator of postural hypotension that occurs when the patient moves from a lying to a sitting or standing position? a) Heart rate decreased from 85 to 75 bpm at the same time that the systolic pressure increased from 120 to 135 mm Hg. b) Heart rate increased from 85 to 110 bpm. c) Diastolic pressure went from 80 to 110 mm Hg. d)Systolic pressure did not change with the change in position

b) Heart rate increased from 85 to 110 bpm.

For both outpatients and inpatients scheduled for diagnostic procedures of the cardiovascular system, the nurse performs a thorough initial assessment to establish accurate baseline data. Which of the following data is necessary to collect if the patient is experiencing chest pain? a)Blood pressure in the left arm b)Description of the pain c)Pulse rate in upper extremities d)Sound of the apical pulses

b)Description of the pain

The nurse is caring for a geriatric client. The client is ordered Lanoxin (digoxin) tablets 0.125mg daily for a cardiac dysrhythmias. Which of the following assessment considerations is essential when caring for this age-group? a)Activity level b)Digoxin level c)Dyspnea d) Cardiac output

b)Digoxin level

The nurse admits a 52-year-old woman with a medical diagnosis of "rule out MI." The client is very frightened and expresses surprise that a woman would have heart problems. Which of the following responses by the nurse would be most appropriate? a) "It takes longer for an electrical impulse to travel from the sinoatrial node to the atrioventricular node." b) "A woman's resting heart rate is lower than a man's." c) "A woman's heart is smaller and has smaller arteries that become occluded more easily." d) "The stroke volume from a woman's heart is lower than from a man's heart.

c) "A woman's heart is smaller and has smaller arteries that become occluded more easily."

When preparing a patient for a cardiac catheterization, the patient states that she has allergies to seafood. Which of the following medications may give to her prior to the procedure? a) Furosemide (Lasix) b) Phenytoin (Dilantin) c) Methylprednisolone (Solu-Medrol) d) Lorazepam (Ativan)

c) Methylprednisolone (Solu-Medrol)

It is important for a nurse to understand cardiac hemodynamics. For blood to flow from the right ventricle to the pulmonary artery, the following must occur: a) The atrioventricular valves must open. b) Right ventricular pressure must decrease with systole. c) Right ventricular pressure must be higher than pulmonary arterial pressure. d) The pulmonic valve must be closed.

c) Right ventricular pressure must be higher than pulmonary arterial pressure.

The clinic nurse caring for a client with a cardiovascular disorder is performing an assessment of the client's pulse. Which of the following steps is involved in determining the pulse deficit? a) Calculate the palpated volume. b) Count the radial pulse for 20 to 25 seconds. c) Calculate the pauses between pulsations. d) Count the heart rate at the apex.

d) Count the heart rate at the apex.

The nurse reviews a patient's lab results and notes a serum calcium level of 7.9 mg/dL. The nurse knows that this reading can also be associated with which of the following? a) Inclination to ventricular fibrillation b) Increased risk of heart block c) Enhanced sensitivity to digitalis d) Impaired myocardial contractility

d) Impaired myocardial contractility

A nurse working in a cardiac step-down unit understands that the following drugs can affect the contractility of the heart. The nurse recognizes that contractility is depressed by which of the following drugs? a) Dobutrex b) Lanoxin c) Intropin d) Lopressor

d) Lopressor