PrepU Chap 22, 23, 24
The nurse is admitting a client with an elevated creatine kinase-MB isoenzyme (CK-MB). What is the cause for the elevated isoenzyme?
myocardial necrosis
The nurse recognizes that the treatment for a non-ST-elevation myocardial infarction (NSTEMI) differs from that for a STEMI, in that a STEMI is more frequently treated with
percutaneous coronary intervention (PCI).
The nurse is assessing a client with suspected post-pericardiotomy syndrome after cardiac surgery. What manifestation will alert the nurse to this syndrome?
pericardial friction rub
The nurse is caring for a client after cardiac surgery. What is the most immediate concern for the nurse?
potassium level of 6 mEq/L
A client presents to the ED with a myocardial infarction. Prior to administering a prescribed thrombolytic agent, the nurse must determine whether the client has which absolute contraindication to thrombolytic therapy?
prior intracranial hemorrhage
The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. Which question by the client indicates a need for clarification?
"I should ask for a handheld device search when I go through airport security."
The client asks the nurse to explain the difference between arteriosclerosis and atherosclerosis. Which is the best explanation the nurse can give to the client?
"Arteriosclerosis is a loss of elasticity of the arteries that accompanies the aging process, whereas atherosclerosis is a condition in which the arteries fill with plaque."
A client comes to the health care provider's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). Which evaluation statement suggests that the client needs more instruction?
"Client walks 4 miles in 1 hour every day."
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?
"Client will verbalize the intention to stop smoking."
A client with a confirmed DVT is being discharged from the ED. Which client statement indicates that the client has received proper nursing instruction and understands how to manage this condition?
"I need to do my leg exercises five times or more every hour."
The nurse is instructing on home care after placement of an implanted cardioverter defibrillator (ICD). Which statement, made by the client, needs clarification by the nurse?
"I need to stay away from microwaves."
A client, who has undergone a percutaneous transluminal coronary angioplasty (PTCA), has received discharge instructions. Which statement by the client would indicate the need for further teaching by the nurse?
"I should expect a low-grade fever and swelling at the site for the next week."
The nurse is educating a client about the care related to a new diagnosis of mitral valve prolapse. What statement made by the client demonstrates understanding of the teaching?
"I will avoid caffeine, alcohol, and smoking."
A nurse is caring for a client with atrial fibrillation. What procedure would the nurse educate the patient about for termination of the dysrhythmia?
Elective cardioversion
A nurse working at a pediatric clinic is teaching a group of parents. A parent asks the nurse if it is okay to let the young child recover from a sore throat naturally, rather than bringing the child to the clinic for diagnosis and treatment. What is the nurse's best response?
"It may be streptococcal sore throat. Rheumatic heart disease can be prevented with early treatment."
A nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers the client to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation?
"Rehabilitation will help me function as well as I physically can."
A client is ordered a nitroglycerine transdermal patch for treatment of CAD and asks the nurse why the patch is removed at bedtime. Which is the best response by the nurse?
"Removing the patch at night prevents drug tolerance while keeping the benefits."
When providing discharge instructions for a client who has been prescribed sublingual nitroglycerin for angina, the nurse should plan to include which instructions?
"See if rest relieves the chest pain before using the nitroglycerin."
The nurse is speaking with a client admitted with a dysrhythmia. The client asks the nurse to explain the "F waves" on the electrocardiogram. What is the nurse's best response?
"The F waves are flutter waves representing atrial activity."
A client with a second-degree atrioventricular heart block, Type II is admitted to the coronary care unit. How will the nurse explain the need to monitor the client's electrocardiogram (ECG) strip to the spouse?
"The small box will transmit the heart rhythm to the central monitor all the time."
A client is receiving anticoagulant therapy. What question will the nurse ask the client to detect any signs of bleeding?
"What color is your urine?"
The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. The client, an avid tennis player, is scheduled to play in a tournament in 1 week. What is the best advice the nurse can give related to this activity?
"You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks."
The nurse is working on a telemetry unit. When the nurse is interpreting a client's heart rhythm, the nurse counts each large block on graph paper as how many seconds?
0.2
The nurse would expect which atrial rate to be an idioventricular rhythm?
20 to 40
A client who had a prosthetic valve replacement was taking warfarin to reduce the risk of postoperative thrombosis. The client visited the nurse at a clinic once a week. What INR level would alert the nurse to notify the health care provider?
3.8
A client asks the nurse how long to wait after taking nitroglycerin before experiencing pain relief. What is the best answer by the nurse?
5 minutes
To be effective, percutaneous transluminal coronary angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction (MI)?
60 minutes
The nurse provides care to a menopausal client, who states, "I read a news article that says I am at risk for coronary vascular disease due to inflammation." Which method should the nurse suggest to the client to aid in the prevention of inflammation that can lead to atherosclerosis?
Addressing obesity
The nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor. What is the priority nursing intervention for the client?
Alerting the healthcare provider of the third-degree heart block
What is the drug of choice for a stable client with ventricular tachycardia?
Amiodarone
Which would the nurse stress as a periodic lifelong necessity for a client managing infective endocarditis?
Antibiotic therapy
The registered nurse reviewed the patient's vital signs and noted a consistent pattern of heart rate recordings between 48 and 58 bpm over a 24-hour period of time. What medication will cause bradycardia?
Atenolol
Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves?
Atrial flutter
The nurse knows that electrocardiogram (ECG) characteristics of atrial fibrillation include what?
Atrial rate of 300 to 400
Which describes a valve used in replacement surgery that is made from the client's own heart valve?
Autograft
A patient has had an implantable cardioverter defibrillator inserted. What should the nurse be sure to include in the education of this patient prior to discharge? (Select all that apply.)
Avoid magnetic fields such as metal detection booths. Call for emergency assistance if feeling dizzy. Record events that trigger a shock sensation.
The nurse is caring for a client with Raynaud syndrome. What is an important instruction for a client who is diagnosed with this disease to prevent an attack?
Avoid situations that contribute to ischemic episodes.
A client is receiving nitroglycerin ointment to treat angina pectoris. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's response and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin?
Blood pressure 84/52 mm Hg
A client with aortic stenosis is reluctant to have valve replacement surgery. A nurse is present when the health care provider talks to the client about a treatment that is less invasive than surgery which will likely relieve some of the client's symptoms. What treatment option has been discussed?
Balloon percutaneous valvuloplasty
The nurse is assisting with a bronchoscopy at the bedside in a critical care unit. The client experiences a vasovagal response. What should the nurse do next?
Check blood pressure.
A middle-aged client presents to the ED reporting severe chest discomfort. Which finding is most indicative of a possible myocardial infarction (MI)?
Chest discomfort not relieved by rest or nitroglycerin
A nurse is caring for a client who has been admitted to have a cardioverter defibrillator implanted. The nurse knows that implanted cardioverter defibrillators are used in which clients?
Clients with recurrent life-threatening tachydysrhythmias
A client had a percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse administer to prevent thrombus formation in the stent?
Clopidogrel
Which medication is given to clients who are diagnosed with angina but are allergic to aspirin?
Clopidogrel
A client comes to the emergency department (ED) reporting precordial chest pain. In describing the pain, the client describes it as pressure with a sudden onset. What disease process would the nurse suspect in this client?
Coronary artery disease
A client is admitted for treatment of Prinzmetal angina. When developing this client's care plan, the nurse should keep in mind that this type of angina is a result of what trigger?
Coronary artery spasm.
The nurse is caring for a client who was admitted to the telemetry unit with a diagnosis of "rule/out acute MI." The client's chest pain began 3 hours earlier. Which laboratory test would be most helpful in confirming the diagnosis of a current MI?
Creatine kinase-myoglobin (CK-MB) level
The nurse is caring for a client with atrial fibrillation. What procedure would be recommended if drug therapies did not control the arrhythmia?
Elective cardioversion
A nurse is caring for a client who experienced an MI. The client is ordered to receive metoprolol. The nurse understands that this medication has which therapeutic effect?
Decreases resting heart rate
The nurse recognizes which as being true of cardioversion?
Defibrillator should be set to deliver a shock during the QRS complex.
The nurse is preparing a client for upcoming electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia. What information will the nurse include in the teaching?
During the procedure, the dysrhythmia will be reproduced under controlled conditions.
The nurse and student nurse are observing a cardioversion procedure. The nurse is correct to tell the student that electrical current will be initiated at which time?
During ventricular depolarization
A client with an atrial dysrhythmia has come to the clinic for a follow-up appointment and to talk with the health care provider about options to stop this dysrhythmia. What procedure could be used to treat this client?
Elective electrical cardioversion
A client is diagnosed with rheumatic endocarditis. What bacterium is the nurse aware causes this inflammatory response?
Group A, beta-hemolytic streptococcus
The nurse is discussing risk factors for developing CAD with a patient in the clinic. Which results would indicate that the patient is not at significant risk for the development of CAD?
High-density lipoprotein (HDL), 80 mg/dL
A nurse is educating a community group about coronary artery disease. One member asks about how to avoid coronary artery disease. Which of the following items are considered modifiable risk factors for coronary artery disease? Choose all that apply.
Hyperlipidemia, Obesity, Tobacco use
Which of the following is inconsistent as a condition related to metabolic syndrome?
Hypotension
A client with endocarditis is being discharged home. What statement indicates effectiveness of client teaching about preventing recurrence of the infection?
I will ask for antibiotics whenever I have dental work done."
A client admitted to the coronary care unit (CCU) diagnosed with a STEMI is anxious and fearful. Which medication will the nurse administer to relieve the client's anxiety and decrease cardiac workload?
IV morphine
When the nurse notes that, after cardiac surgery, the client demonstrates low urine output (less than 25 mL/h) with high specific gravity (greater than 1.025), the nurse suspects which condition?
Inadequate fluid volume
Which is the most important postoperative assessment parameter for a client recovering from cardiac surgery?
Inadequate tissue perfusion
The nurse notes that the post cardiac surgery client demonstrates low urine output (< 25 mL/hr) with high specific gravity (> 1.025). What will the nurse anticipate the health care provider will order?
Increase intravenous fluids
A client has been recently placed on nitroglycerin. Which instruction by the nurse should be included in the client's teaching plan?
Instruct the client on side effects of flushing, throbbing headache, and tachycardia.
Which nursing intervention is required to prepare a client with cardiac dysrhythmia for an elective electrical cardioversion?
Instruct the client to restrict food and oral intake
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?
Lead wire dislodgement
Which discharge instruction for self-care should the nurse provide to a client who has undergone a percutaneous transluminal coronary angioplasty (PTCA) procedure?
Monitor the site for bleeding or hematoma.
Which nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia?
Monitor vital signs and cardiac rhythm
The nurse expects to see which of the following characteristics on an ECG strip for a patient who has third-degree AV block?
More P waves than QRS complexes
Severe chest pain is reported by a client during an acute myocardial infarction. Which of the following is the most appropriate drug for the nurse to administer?
Morphine sulfate (Morphine)
An operating room nurse is caring for a client who is having a pacemaker implanted. The health care provider has requested a demand mode pacemaker for this client. What is this type of pacemaker?
Self-activated
The nurse is analyzing the cardiac rhythm of a client with a pacemaker and notes the QRS complex is absent after pacer spike. The nurse knows that reading can be caused by which of the following factors?
Pacer undersensing
The nurse is reviewing the lab work of a client diagnosed with infective endocarditis. Which diagnostic study confirms the diagnosis?
Positive blood culture
A patient in the recovery room after cardiac surgery begins to have extremity paresthesia, peaked T waves, and mental confusion. What type of electrolyte imbalance does the nurse suspect this patient is having?
Potassium
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?
Premature ventricular contraction (PVC)
The nurse is caring for a client following a coronary artery bypass graft (CABG). The nurse notes persistent oozing of bloody drainage from various puncture sites. The nurse anticipates that the physician will order which medication to neutralize the unfractionated heparin the client received?
Protamine sulfate
A client has had oral anticoagulation ordered. What should the nurse monitor for when the client is taking oral anticoagulation?
Prothrombin time (PT) or international normalized ratio (INR)
The nurse is placing electrodes for a 12-lead electrocardiogram (ECG). The nurse would be correct in placing an electrode on which area for V1?
Right side of sternum, fourth intercostal space
The nurse is caring for a client presenting to the emergency department (ED) reporting chest pain. Which electrocardiographic (ECG) finding would be most concerning to the nurse?
ST elevation
The nurse is teaching a beginning EKG class to staff nurses. As the nurse begins to discuss the parts of the EKG complex, one of the students asks what the normal order of conduction through the heart is. What order does the nurse describe?
Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers
A client reports chest pain that occurs when playing tennis but resolves when sitting down. The nurse knows these symptoms are common for which type of angina?
Stable
The client is prescribed nadolol for hypertension. What is the reason the nurse will teach the client not to stop taking the medication abruptly?
The abrupt stop can cause a myocardial infarction.
A client with heart failure asks the nurse how dobutamine affects the body's circulation. What is the nurse's best response?
The medication increases the force of the myocardial contraction.
A client has been diagnosed with atrial fibrillation and has been prescribed warfarin therapy. What should the nurse prioritize when providing health education to the client?
The need to have regular blood levels drawn
A patient with coronary artery disease (CAD) is having a cardiac catheterization. What indicator is present for the patient to have a coronary artery bypass graft (CABG)?
The patient has at least a 70% occlusion of a major coronary artery.
In the treatment of coronary artery disease (CAD), medications are often ordered to control blood pressure in the client. Which of the following is a primary purpose of using beta-adrenergic blockers in the nursing management of CAD?
To decrease workload of the heart
The nurse is teaching a client diagnosed with aortic stenosis appropriate strategies for attempting to relieve the symptom of angina without resorting to taking medications. What should the nurse teach the client?
To rest and relax before taking nitroglycerin
Which instruction should a nurse provide a client with a history of rheumatic fever before the client has any dental work done?
To take prophylactic antibiotics
Which electrocardiogram (ECG) characteristic is usually seen when a client's serum potassium level is low?
U wave
Which term refers to preinfarction angina?
Unstable angina
A nurse is teaching a client about maintaining a healthy heart. What information will the nurse include with the teaching?
Use alcohol in moderation.
Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty?
Withhold anticoagulant therapy.
The nurse is explaining the cause of angina pain to a client. What will the nurse say most directly caused the pain?
a lack of oxygen in the heart muscle cells
A client is diagnosed with pericarditis. What symptom will be the nurse's priority for treatment?
acute pain
The nurse is caring for a ventilated client after coronary artery bypass graft surgery. What are the criterions for extubation for the client? Select all that apply.
adequate cough and gag reflexes, acceptable arterial blood gas values, breathing without assistance of the ventilator
A client has had a 12-lead ECG completed as part of an annual physical examination. The nurse notes an abnormal Q wave on an otherwise unremarkable ECG. The nurse recognizes that this finding indicates
an old MI.
The nurse is removing a client's femoral sheath after cardiac catheterization. What medication will the nurse have available?
atropine sulfate
Which is not a likely origination point for cardiac arrhythmias?
bundle of His
A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is categorized as which type of drug?
calcium-channel blocker
The nurse is admitting a client to a telemetry unit with an atrial dysrhythmia. What symptoms will the nurse further evaluate?
chest pain
A client who has been diagnosed with Prinzmetal's angina will present with which symptom?
chest pain that occurs at rest and usually in the middle of the night
The nurse witnesses a client experiencing ventricular fibrillation. What is the nurse's priority action?
defibrillation
A client with a history of mitral stenosis is admitted to the intensive care unit (ICU) with the abrupt onset of atrial fibrillation. The client's heart rate ranges from 120 to 140 bpm. The nurse recognizes that interventions are implemented to prevent the development of
embolic stroke.
A client's lipid profile reveals an LDL level of 122 mg/dL. This is considered a:
high LDL level.
The nurse is caring for a client with coronary artery disease. What is the nurse's priority goal for the client?
enhance myocardial oxygenation
A nurse is caring for a client with end-stage cardiomyopathy and the client's spouse asks the nurse to clarify one of the last treatment options available that the health care provider mentioned. What is considered to be one of the last treatments for end-stage cardiomyopathy?
heart transplantation
A nurse is teaching a client about mitral stenosis. What is the key teaching point regarding the disruption to the normal flow of blood through the heart due to mitral stenosis?
increased resistance of a narrowed orifice between the left atrium and the left ventricle
The nurse is caring for a client who has been diagnosed with aortic stenosis. The client is prescribed digoxin. What is the rationale for the medication?
left ventricular dysfunction
A nurse is caring for a young female adult client diagnosed with atrial fibrillation who has just had a mitral valve replacement. The client is being discharged with prescribed warfarin. The client mentions to the nurse that she relies on the rhythm method for birth control. What education will be a priority for the nurse to provide to this client?
the high risk for complications if she becomes pregnant while taking warfarin
The nurse working in the emergency department places a client in anaphylactic shock on a cardiac monitor and sees the cardiac rhythm shown. Which dysrythmia should the nurse document?
ventricular tachycardia