PrepU chpt 25
Central venous pressure is measured in which of the following heart chambers? a) Left ventricle b) Right ventricle c) Left atrium d) Right atrium
d. Right atrium Explanation: The pressure in the right atrium is used to assess right ventricular function and venous blood return to the heart. The left atrium receives oxygenated blood from the pulmonary circulation. The left ventricle receives oxygenated blood from the left atrium. The right ventricle is not the central collecting chamber of venous circulation.
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? a) The patient may have had a myocardial infarction. b) The patient may have an abdominal aortic aneurysm. c) The patient was anxious about being constipated. d) The patient had a vagal response.
d. The patient had a vagal response. Explanation: When straining during defecation, the patient bears down (the Valsalva maneuver), which momentarily increases pressure on the baroreceptors. This triggers a vagal response, causing the heart rate to slow and resulting in syncope in some patients. Straining during urination can produce the same response.
The nurse prepares to auscultate heart sounds. Which nursing interventions would be most effective to assist with this procedure? a) Explain to the client that the nurse will be listening to different areas of the chest and may listen for a long time, but that does not mean that anything abnormal is heard. b) Ask the client to take deep breaths through his mouth while the nurse auscultates heart sounds. c) Ask the client to sit on the edge of the bed and hold his breath while the nurse listens. d) Insist that the family members leave the room if they must speak to each other while the nurse is auscultating heart sounds.
A) Explain to the client that the nurse will be listening to different areas of the chest and may listen for a long time, but that does not mean that anything abnormal is heard. Explanation: During auscultation the client remains supine and the room should be as quiet as possible while the nurse listens to heart sounds. The client should breathe quietly during the examination.
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 Explanation: Chest pain, weight gain, fatigue, dizziness, ascites, and confusion are all symptoms of CVD. Rash, extra-ocular eye movements, ecchymosis, and petechiae are not usually indicative of CVD
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])? a) Administer calcium supplements. b) Assess for hypokalemia. c) Report any incident of bloody urine, stools, or both. d) Assess for clubbing of the fingers.
c. Report any incident of bloody urine, stools, or both. Explanation: The client who takes an anticoagulant, such as a low-molecular-weight heparin, is routinely screened for bloody urine, stools, or both.
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? a) Vagus nerve b) Chemoreceptors c) Sympathetic nerve fibers d) Baroreceptors
d. Baroreceptors Explanation: Baroreceptor sense pressure in nerve endings in the walls of the atria and major blood vessels. The baroreceptors respond accordingly to raise or lower the pressure. Chemoreceptors are sensitive to pH, CO2, and O2 in the blood. Sympathetic nerve fibers increase the heart rate. The vagus nerve slows the heart rate.
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) Mg++ 2 mE/L b) Na+ 140 mEq/L c) Ca++ 9 mg/dL d) K+ 3.1 mEq/L
d. K+ 3.1 mEq/L Explanation: All are within normal limits except for the K+, which is low. A low K+ level can cause ventricular tachycardia or fibrillation.
Which of the following is an early warning symptom of acute coronary syndrome (ACS) and heart failure (HF)? a) Weight gain b) Change in level of consciousness c) Fatigue d) Hypotension
c. Fatigue Explanation: Fatigue is an early warning symptom of ACS, heart failure, and valvular disease. Other signs and symptoms of cardiovascular disease are hypotension, change in level of consciousness, and weight gain.
The ability of the cardiac muscle to shorten in response to an electrical impulse is termed which of the following? a) Contractility b) Depolarization c) Diastole d) Repolarization
a) Contractility Explanation: Contractility is the ability of the cardiac muscle to shorten in response to an electrical impulse. Depolarization is the electrical activation of a cell caused by the influx of sodium into the cell while potassium exits the cell. Repolarization is the return of the cell to the resting state, caused by reentry of potassium into the cell while sodium exits the cell. Diastole is the period of ventricular relaxation resulting in ventricular filling.
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?" Explanation: Ask if the client has episodes of dyspnea, dizziness, or fainting. Options B, C, and D are incorrect. Being nauseous, mottling of the hands, and pain radiating into the lower extremities are not indications of cardiac problems.
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? a) Contact the physician and report her findings. b) Encourage the client to perform isometric leg exercise to improve circulation in his legs. c) Document her findings and recheck the client in 1 hour. d) Slow the I.V. fluid to prevent any more swelling at the puncture site.
a. Contact the physician and report her findings. Explanation: The client is probably developing a hematoma at the puncture site. The decreased pulses, swelling, and cool temperature in the leg are all classic signs that blood flow to that extremity is compromised. The nurse should notify the physician immediately to preserve the blood flow in the client's leg. Documenting findings and checking the client again in 1 hour, slowing the I.V. fluid, and encouraging the client to perform isometric leg exercises aren't appropriate actions for the nurse to take at this time.
The nurse is caring for an elderly client with left-sided heart failure. When auscultating lung sounds, which adventitious sound is expected? a) Crackles b) Coarseness c) Wheezes d) Rhonchi
a. Crackles Explanation: When the heart is pumping inefficiently, blood backs up into the pulmonary veins and lung tissue. Auscultation reveals a crackling sound. Possible wheezes and gurgles are also possibilities.
Within the heart, several structures and several layers all play a part in protecting the heart muscle and maintaining cardiac function. The inner layer of the heart is composed of a thin, smooth layer of cells, the folds of which form heart valves. What is the name of this layer of cardiac tissue? a) Endocardium b) Myocardium c) Pericardium d) Epicardium
a. Endocardium Explanation: The inner layer, the endocardium, is composed of a thin, smooth layer of endothelial cells. Folds of endocardium form the heart valves. The middle layer, the myocardium, consists of muscle tissue and is the force behind the heart's pumping action. The pericardium is a saclike structure that surrounds and supports the heart. The outer layer, the epicardium, is composed of fibrous and loose connective tissue.
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? a) Erb's point b) Epigastric area c) Aortic area d) Pulmonic area
a. Erb's point Explanation: Erb's point is located at the third IC space to the left of the sternum. The aortic area is located at the second IC space to the right of the sternum. The pulmonic area is at the second IC space to the left of the sternum. The epigastric area is located below the xiphoid process.
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) Impaired myocardial contractility b) Increased risk of heart block c) Inclination to ventricular fibrillation d) Enhanced sensitivity to digitalis
a. Impaired myocardial contractility Explanation: Normal serum calcium is 8.9 to 10.3 mg/dL. A reading of 7.9 is below normal. Hypocalcemia is associated with slow nodal functioning and impaired myocardial contractility, which can increase the risk of heart failure.
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) Lopressor b) Intropin c) Dobutrex d) Lanoxin
a. Lopressor Contractility is depressed by beta-adrenergic blocking medications. The other choices all enhance contractility.
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? a) Myocardial ischemia b) A stroke c) Right-sided heart failure d) A pulmonary embolism
a. Myocardial ischemia Explanation: As heart rate increases, diastolic time is shortened, which may not allow adequate time for myocardial perfusion. As a result, patients are at risk for myocardial ischemia (inadequate oxygen supply) during tachycardias (heart rate greater than 100 bpm), especially patients with coronary artery disease.
You are the clinic nurse doing assessments on your clients before they have outpatient diagnostic testing done. What would you document when assessing the client's pulse? a) Rate, quality, and rhythm b) Rate, rhythm, and volume c) Quality, volume, and rate d) Pressure, rate, and rhythm
a. Rate, quality, and rhythm Explanation: Assess apical and radial pulses, noting rate, quality, and rhythm. Pulse quality and volume are not assessed in this instance.
Admission lab values on a patient admitted with congestive heart failure are as follows: potassium 3.4 mEq/L; sodium 148 mEq/L; calcium 9.8 mg/dL; and magnesium 1.5 mEq/L. Which lab value is abnormal? a) Sodium b) Magnesium c) Potassium d) Calcium
a. Sodium Explanation: The normal sodium level is 135 to 145 mEq/L. Potassium ranges from 3.3 to 4.9 mEq/L. The normal calcium level is 8.9 to 10.3 mg/dL. Magnesium levels range from 1.3 to 2.2 mEq/L.
A nurse is preparing a client for magnetic resonance imaging (MRI) to confirm or rule out a spinal cord lesion. During the MRI scan, which action would pose a threat to the client? a) The client wears a watch and wedding band. b) The client asks questions. c) The client hears thumping sounds. d) The client lies still.
a. The client wears a watch and wedding band. Explanation: During an MRI, the client should wear no metal objects, such as jewelry, because the strong magnetic field can pull on them, causing injury to the client and (if they fly off) to others. The client must lie still during the MRI, but he can talk to those performing the test by way of the microphone inside the scanner tunnel. The client should hear thumping sounds, which are caused by the sound waves thumping on the magnetic field.
The nurse is reviewing discharge instructions with a patient who underwent a left groin cardiac catheterization 8 hours ago. Which of the following instructions should the nurse include? a) "You can take a tub bath or a shower when you get home." b) "Do not bend at the waist, strain, or lift heavy objects for the next 24 hours." c) "Contact your primary care provider if you develop a temperature above 102°F." d) "If any discharge occurs at the puncture site, call 911 immediately."
b. "Do not bend at the waist, strain, or lift heavy objects for the next 24 hours." Explanation: The nurse should instruct the patient to complete the following: If the artery of the groin was used, for the next 24 hours, do not bend at the waist, strain, or lift heavy objects; the primary provider should be contacted if any of the following occur: swelling, new bruising or pain from your procedure puncture site, temperature of 101°F or more. If bleeding occurs, lie down (groin approach) and apply firm pressure to the puncture site for 10 minutes. Notify the primary provider as soon as possible and follow instructions. If there is a large amount of bleeding, call 911. The patient should not drive to the hospital
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? a) "Having an orgasm is very strenuous and your husband must be in excellent physical shape before attempting it." b) "The physiologic demands are greatest during orgasm and are equivalent to walking 3 to 4 miles per hour on a treadmill." c) "It is usually better to just give up sex after a heart attack." d) "The medications will prevent your husband from having an erection."
b. "The physiologic demands are greatest during orgasm and are equivalent to walking 3 to 4 miles per hour on a treadmill." Explanation: The physiologic demands are greatest during orgasm. The level of activity is equivalent to walking 3 to 4 miles per hour on a treadmill. Erectile dysfunction may be a side effect of beta-blockers, but other medications may be substituted.
The nurse is caring for a client on a monitored telemetry unit. During morning assessment, the nurse notes abnormal ECG waves on the telemetry monitor. Which action would the nurse do first? a) Assess for mechanical dysfunction. b) Assess the client. c) Call the physician with a report. d) Reposition the client.
b. Assess the client. When a nurse notes an abnormal rhythm on a telemetry monitor, the first action is to assess the client. After client assessment, the nurse is able to make an informed decision on the next nursing action.
A patient has undergone a cardiac catheterization. He is to be discharged today. What information should the nurse emphasize during discharge teaching? a) New bruising at the puncture site is normal. b) Avoid heavy lifting for the next 24 hours. c) Bend only at the waist. d) Take a tub bath, rather than a shower.
b. Avoid heavy lifting for the next 24 hours. Explanation: For the next 24 hours, the patient should not bend at the waist, strain, or life heavy objects. The patient should avoid tub baths, but shower as desired. The patient should call her the health care provider if she has any bleeding, swelling, new bruising, or pain from her procedure puncture site, or a temperature of 101.5 degrees Fahrenheit or more.
The nurse is providing discharge education for the client going home after a cardiac catheterization. Which of the following would be important information to give this client? a) Expect bruising to appear at the site. b) Avoid tub baths, but shower as desired. c) Returning to work immediately is okay. d) Do not ambulate until the physician indicates it is appropriate.
b. Avoid tub baths, but shower as desired. Explanation: Guidelines for self-care after hospital discharge following a cardiac catheterization include shower as desired (no tub baths), avoid bending at the waist and lifting heavy objects, the physician will indicate when it is okay to return to work, and notify the physician right away if you have bleeding, new bruising, swelling, or pain at the puncture site.
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? a) Pneumothorax b) Catheter-related bloodstream infections (CRBSI) c) Hemorrhage d) Air embolism
b. Catheter-related bloodstream infections (CRBSI) Explanation: CRBSIs are the most common preventable complication associated with hemodynamic monitoring systems. Comprehensive guidelines for the prevention of these infections have been published by Centers for Disease Control and Prevention (CDC). Complications from use of hemodynamic monitoring systems are uncommon and can include pneumothorax, infection, and air embolism. A pneumothorax may occur during the insertion of catheters using a central venous approach (CVP and pulmonary artery catheters). Air emboli can be introduced into the vascular system if the stopcocks attached to the pressure transducers are mishandled during blood drawing, administration of medications, or other procedures that require opening the system to air.
You are monitoring the results of laboratory tests performed on a client admitted to the cardiac ICU with a diagnosis of myocardial infarction. Which test would you expect to show elevated levels? a) RBC b) Enzymes c) WBC d) Platelets
b. Enzymes Explanation: When tissues and cells break down, are damaged, or die, great quantities of certain enzymes are released into the bloodstream. Enzymes can be elevated in response to cardiac or other organ damage. After an MI, RBCs and platelets should not be elevated. WBCs would only be elevated if there was a bacterial infection present.
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? a) Take the blood pressure in both arms. b) Palpate a peripheral pulse. c) Percuss the perimeter of the heart. d) Auscultate the carotid artery.
b. Palpate a peripheral pulse. Explanation: A cardiac monitor reveals the heart's electrical but not its mechanical activity. The healthcare provider must palpate a peripheral pulse or auscultate the apical heart rate to obtain this information. You cannot obtain information on the mechanical activity of the heart by taking the client's blood pressure, auscultating the carotid artery, or attempting to percuss the perimeter of the heart.
The nurse is observing a patient during an exercise stress test (bicycle). Which of the following findings indicates a positive test and the need for further diagnostic testing? a) BP changes; 148/80 mm Hg to 166/90 mm Hg b) ST-segment changes on the ECG c) Heart rate changes; 78 bpm to 112 bpm d) Dizziness and leg cramping
b. ST-segment changes on the ECG Explanation: During the test, the following are monitored: two or more ECG leads for heart rate, rhythm, and ischemic changes; BP; skin temperature; physical appearance; perceived exertion; and symptoms, including chest pain, dyspnea, dizziness, leg cramping, and fatigue. The test is terminated when the target heart rate is achieved or if the patient experiences signs of myocardial ischemia. Further diagnostic testing, such as a cardiac catheterization, may be warranted if the patient develops chest pain, extreme fatigue, a decrease in BP or pulse rate, serious dysrhythmias or ST-segment changes on the ECG during the stress test. The other findings would not warrant the testing to be stopped.
Which of the following terms describes the amount of blood ejected per heartbeat? a) Ejection fraction b) Stroke volume c) Afterload d) Cardiac output
b. Stroke volume Explanation: Stroke volume is determined by preload, afterload, and contractility of the heart. Cardiac output is the amount of blood pumped by each ventricle during a given period and is computed by multiplying the stroke volume of the heart by the heart rate. Ejection fraction is the percentage of the end-diastolic volume that is ejected with each stroke, measured at 42% to 50% in the normal heart. Afterload is defined as the pressure that the ventricular myocardium must overcome to eject blood during systole and is one of the determinants of stroke volume.
A patient recently diagnosed with pericarditis asks his nurse to explain what area of his heart is involved. The nurse tells the patient that the pericardium, which is inflamed, is the: a) Inner lining of the heart and valves. b) Thin fibrous sac that encases the heart. c) Exterior layer of the heart. d) Heart's muscle fibers.
b. Thin fibrous sac that encases the heart. Explanation: The pericardium is a thin, fibrous sac that encases the heart. It is composed of two layers, the visceral and the parietal pericardium. The space between these two layers is filled with fluid.
The client, an 83-year-old man, is admitted with heart faillure. The nurse is aware that education needed prior to discharge includes which of the following? a) Continue to increase the amount of exercise, because cardiac output increases with age. b) Try to avoid emotional stress and take part in mild physical stress only. c) Any kind of stress is acceptable, because the aging heart has an increased ability to respond. d) Exercise tolerance should remain the same as in younger years.
b. Try to avoid emotional stress and take part in mild physical stress only. Explanation: Stressful physical and emotional conditions may have adverse effects on the aged person's heart.
Decreased pulse pressure reflects a) reduced distensibility of the arteries. b) reduced stroke volume. c) tachycardia. d) elevated stroke volume.
b. reduced stroke volume. Explanation: Decreased pulse pressure reflects reduced stroke volume and ejection velocity or obstruction to blood flow during systole. Increased pulse pressure would indicate reduced distensibility of the arteries, along with bradycardia.
The nurse is caring for a patient with diabetes who is scheduled for a cardiac catheterization. Prior to the procedure, it is most important for the nurse to ask which of the following questions? a) "Are you having chest pain?" b) "What was your morning blood sugar reading?" c) "Are you allergic to shellfish?" d) "When was the last time you ate or drank?"
c. "Are you allergic to shellfish?" Explanation: Radiopaque contrast agents are used to visualize the coronary arteries. Some contrast agents contain iodine, and the patient is assessed before the procedure for previous reactions to contrast agents or allergies to iodine-containing substances (e.g., seafood). If the patient has a suspected or known allergy to the substance, antihistamines or methylprednisolone (Solu-Medrol) may be administered before the procedure. Although the other questions are important to ask the patient, it is most important to ascertain if the patient has an allergy to shellfish.
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? a) Platelet count b) Potassium c) B-type natriuretic peptide (BNP) d) C-reactive protein (CRP)
c. B-type natriuretic peptide (BNP) Explanation: The client's symptoms suggest heart failure. BNP is a neurohormone that's released from the ventricles when the ventricles experience increased pressure and stretch, such as in heart failure. A BNP level greater than 51 pg/ml is commonly associated with mild heart failure. As the BNP level increases, the severity of heart failure increases. Potassium levels aren't affected by heart failure. CRP is an indicator of inflammation. It's used to help predict the risk of coronary artery disease. There is no indication that the client has an increased CRP. There is no indication that the client is experiencing bleeding abnormalities, such as those seen with an abnormal platelet count.
The nurse is caring for a client who has just returned from the cadiac catheterization laboratory following a coronary angioplasty. Which of the following assessments will the nurse do immediately? a) Assess for PERRLA. b) Check the client's tolerance to ambulation to the bathroom. c) Check the temperature, color, and capillary refill of the affected extremity. d) Assess when the client last had a bowel movement.
c. Check the temperature, color, and capillary refill of the affected extremity. Explanation: Nursing responsibilities after cardiac catheterization include frequent checks of the temperature, color, and capillary refill of the affected extremity. The client is also assessed for extremity pain, numbness, or tingling sensation. These could all indicate arterial insufficiency.
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? a) Clopidogrel (Plavix) b) Enoxaparin (Lovenox) c) Digoxin (Lanoxin) d) Heparin
c. Digoxin (Lanoxin) Explanation: Contractility is enhanced by circulating catecholamines, sympathetic neuronal activity, and certain medications, such as Lanoxin. Increased contractility results in increased stroke volume. The other medications are classified as platelet-inhibiting medications.
The client with a diagnosis of heart failure reports frequently awakening during the night with the need to urinate. The nurse offers which explanation? a) The blood pressure is lower when the client is recumbent and this causes the kidneys to work harder; therefore, more urine is produced. b) Fluid that is held in the lungs during the day becomes part of the circulation at night and the kidneys produce an increased amount of urine. c) 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. d) When the client is in the recumbent position, more pressure is put on the bladder with the result of increased need to urinate.
c. 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. Explanation: Nocturia is common in patients with heart failure. Fluid collected in dependent areas during the day is reabsorbed into the circulation at night when the client is recumbent. The kidneys excrete more urine with the increased circulating volume.
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? a) Complete blood count (CBC) b) Sodium c) International normalized ratio (INR) d) Partial thromboplastic time (PTT)
c. International normalized ratio (INR) Explanation: The INR, reported with the PT, provides a standard method for reporting PT levels and eliminates the variation of PT results from different laboratories. The INR, rather than the PT alone, is used to monitor the effectiveness of warfarin. The therapeutic range for INR is 2 to 3.5, although specific ranges vary based on diagnosis. The other laboratory values are not used to evaluate the effectiveness of Coumadin.
Within the physiology of the heart, each chamber has a particular role in maintaining cellular oxygenation. Which chamber of the heart is responsible for receiving oxygenated blood from the lungs? a) Right ventricle b) Right atrium c) Left atrium d) Left ventricle
c. Left atrium The left atrium receives oxygenated blood from the lungs. The left ventricle pumps that blood to all the cells and tissues of the body. The right atrium receives deoxygenated blood from the venous system. The right ventricle pumps that blood to the lungs to be oxygenated.
The nurse is caring for a patient with clubbing of the fingers and toes. The nurse should complete which of the following actions given these findings? a) Assess the patient's capillary refill. b) Obtain a 12-lead ECG tracing. c) Obtain an oxygen saturation level. d) Assess the patient for pitting edema.
c. Obtain an oxygen saturation level. Explanation: Clubbing of the fingers and toes indicates chronic hemoglobin desaturation (decreased oxygen supply) and is associated with congenital heart disease. The nurse should assess the patient's O2 saturation level and intervene as directed. The other assessments are not indicated.
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? a) Nausea b) Rash c) Orthostatic hypotension d) Dry mouth
c. Orthostatic hypotension Explanation: A common side effect of Nitrostat, especially at higher dosages, is orthostatic hypotension. The action of the medication is to dilate the blood vessels to improve circulation to the heart. The side effect of the medication is orthostatic hypotension. A rash, nausea, and dry mouth are not common side effects.
Which of the following is the term for the normal pacemaker of the heart? a) Bundle of His b) Atrioventricular (AV) node c) Sinoatrial (SA) node d) Purkinje fibers
c. Sinoatrial (SA) node Explanation: The sinoatrial node is the primary pacemaker of the heart. The AV node coordinates the incoming electrical impulses from the atria and, after a slight delay, relays the impulse to the ventricles. The Purkinje fibers rapidly conduct the impulses through the thick walls of the ventricles.
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 at risk for bleeding. b) The client is over-hydrated, which puts him at risk for heart failure during the procedure. c) The client is at risk for renal failure due to the contrast agent that will be given during the procedure. d) These values show a risk for dysrhythmias.
c. The client is at risk for renal failure due to the contrast agent that will be given during the procedure. Explanation: The contrast medium must be excreted by the kidneys. If there is already a degree of renal impairment (which these laboratory values indicate), the risk for contrast agent-induced nepropathy and renal failure is high.
The nurse is caring for a patient with a diagnosis of pericarditis. Where does the nurse understand the inflammation is located? a) The exterior layer of the heart b) The heart's muscle fibers c) The thin fibrous sac encasing the heart d) The inner lining of the heart and valves
c. The thin fibrous sac encasing the heart Explanation: The heart is encased in a thin, fibrous sac called the pericardium, which is composed of two layers. Inflammation of this sac is known as pericarditis.
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? a) Myoglobin b) CK-MB c) Troponin T and I d) Brain natriuretic peptide (BNP)
c. Troponin T and I Explanation: After myocardial injury, these biomarkers rise early (within 3 to 4 hours), peak in 4 to 24 hours, and remain elevated for 1 to 3 weeks. These early and prolonged elevations may make very early diagnosis of acute myocardial infarction (MI) possible and allow for late diagnosis in patients who have delayed seeking care for several days after the onset of acute MI symptoms. CK-MB returns to normal within 3 to 4 days. Myoglobin returns to normal within 24 hours. BNP is not considered a cardiac biomarker. It is a neurohormone that responds to volume overload in the heart by acting as a diuretic and vasodilator.
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) "The stroke volume from a woman's heart is lower than from a man's heart." c) "A woman's resting heart rate is lower than a man's." d) "A woman's heart is smaller and has smaller arteries that become occluded more easily."
d. "A woman's heart is smaller and has smaller arteries that become occluded more easily." Explanation: Because the coronary arteries of a woman are smaller, they become occluded from atherosclerosis more easily. In addition, the resting rate, stroke volume, and ejection fraction of a woman's heart are higher than those of a man.
The nurse is caring for a client anticipating further testing related to cardiac blood flow. Which statement, made by the client, would lead the nurse to provide additional teaching? a) "I am able to have a nuclide study because I do not have any allergies." b) "I had an ECG already. It provided information on my heart rhythm. c) "The first test I am getting is an echocardiography. I am glad that it is not painful." d) "My niece thought that I would be ordered a magnetic resonance imaging even though I have a pacemaker."
d. "My niece thought that I would be ordered a magnetic resonance imaging even though I have a pacemaker." Explanation: A magnetic resonance imaging (MRI) test is prohibited on clients with various metal devices within their body. External metal objects must be removed. All other options are correct statements not needing clarification.
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) Apply baby powder to the patient's chest prior to placing the electrodes. b) Once the electrodes are applied, change them every 72 hours. c) Clean the patient's chest with alcohol prior to application of the electrodes. d) Clip the patient's chest hair prior to applying the electrodes.
d. Clip the patient's chest hair prior to applying the electrodes. Explanation: The nurse should complete the following actions when applying cardiac electrodes: Clip (do not shave) hair from around the electrode site, if needed; if the patient is diaphoretic (sweaty), apply a small amount of benzoin to the skin, avoiding the area under the center of the electrode; debride the skin surface of dead cells with soap and water and dry well (or as recommended by the manufacturer). Change the electrodes every 24 to 48 hours (or as recommended by the manufacturer); examine the skin for irritation and apply the electrodes to different locations.
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) Sound of the apical pulses b) Pulse rate in upper extremities c) Blood pressure in the left arm d) Description of the pain
d. Description of the pain Explanation: If the patient is experiencing chest pain, a history of its location, frequency, and duration is necessary, as is a description of the pain, if it radiates to a particular area, what precipitates its onset, and what brings relief. The nurse weighs the patient and measures vital signs. The nurse may measure BP in both arms and compare findings. The nurse assesses apical and radial pulses, noting rate, quality, and rhythm. The nurse also checks peripheral pulses in the lower extremities.
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) Dyspnea b) Cardiac output c) Activity level d) Digoxin level
d. Digoxin level Explanation: The action of Digoxin slows and strengthens the heart rate. Assessment of the pulse rate is essential prior to administration in all clients. Due to decreased perfusion common in geriatric clients, toxicity may occur more often. The nurse must monitor Digoxin levels in the body. Monitoring symptoms reflecting cardiac output, activity level, and dyspnea are also important assessment considerations for all clients.
The nurse caring for a client who is suspected of having cardiovascular disease has a stress test ordered. The client has a co-morbidity of multiple sclerosis, so the nurse knows the stress test will be drug-induced. What drug will be used to dilate the coronary arteries? a) Thallium b) Ativan c) Diazepam d) Dobutamine
d. Dobutamine Explanation: Drugs such as adenosine (Adenocard), dipyridamole (Persantine), or dobutamine (Dobutrex) may be administered singularly or in combination by the IV route. The drugs dilate the coronary arteries, similar to the vasodilation that occurs when a person exercises to increase the heart muscle's blood supply. Options A, B, and C would not dilate the coronary arteries.
The nurse auscultates the apex beat at which of the following anatomical locations? a) 2 inch to the left of the lower end of the sternum b) Midsternum c) 1 inch to the left of the xiphoid process d) Fifth intercostal space, midclavicular line
d. Fifth intercostal space, midclavicular line Explanation: The left ventricle is responsible for the apex beat or the point of maximum impulse, which is normally palpable in the left midclavicular line of the chest wall at the fifth intercostal space. The right ventricle lies anteriorly, just beneath the sternum. Use of inches to identify the location of the apex beat is inappropriate based upon variations in human anatomy. Auscultation below and to the left of the xiphoid process will detect gastrointestinal sounds, but not the apex beat of the heart.
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? a) Pericarditis b) Myocardial infarction c) Pulmonary embolism d) Heart failure
d. Heart failure Explanation: An ejection fraction of less than 40% indicates that the patient has decreased left ventricular function and likely requires treatment for heart failure.
A nurse is reviewing laboratory values for a client diagnosed with hyperlipidemia 6 months ago. Which results indicate that the client has been following his therapeutic regimen? a) Triglycerides increase from 225 mg/dl to 250 mg/dl. b) Total cholesterol level increases from 250 mg/dl to 275 mg/dl. c) Low density lipoproteins (LDL) increase from 180 mg/dl to 190 mg/dl. d) High density lipoproteins (HDL) increase from 25 mg/dl to 40 mg/dl.
d. High density lipoproteins (HDL) increase from 25 mg/dl to 40 mg/dl. Explanation: The goal of treating hyperlipidemia is to decrease total cholesterol and LDL levels while increasing HDL levels. HDL levels should be greater than 35 mg/dl. This client's increased HDL levels indicate that he's followed his therapeutic regimen. Recommended total cholesterol levels are below 200 mg/dl. LDL levels should be less than 160 mg/dl, or, in clients with known coronary artery disease (CAD) or diabetes mellitus, less than 70 mg/dl. Triglyceride levels should be between 100 and 200 mg/d.
The nurse is administering a beta blocker to a patient in order to decrease automaticity. Which medication will the nurse administer? a) Cordarone b) Cardizem c) Rythmol d) Lopressor
d. Lopressor Explanation: Patients may receive beta-blockers prior to the scan to control heart rate and rhythm.
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) Phenytoin (Dilantin) b) Furosemide (Lasix) c) Lorazepam (Ativan) d) Methylprednisolone (Solu-Medrol)
d. Methylprednisolone (Solu-Medrol) Explanation: Prior to cardiac catheterization, the patient is assessed for previous reactions to contrast agents or allergies to iodine-containing substances, as some contrast agents contain iodine. If allergic reactions are of concern, antihistamines or methylprednisolone (Solu-Medrol) may be administered to the patient before angiography is performed. Lasix, Ativan, and Dilantin do not counteract allergic reactions.
The nurse is caring for a client with ECG changes consistent with a myocardial infarction. Which of the following diagnostic test does the nurse anticipate to confirm heart damage? a) Chest radiography b) Serum blood work c) Fluoroscopy d) Nuclear cardiology
d. Nuclear cardiology Explanation: Nuclear cardiology uses a radionuclide to detect areas of myocardial damage. Chest radiography and fluoroscopy determine the size and position of the heart and condition of the lungs. Serum blood work notes elevations in enzymes suggesting muscle damage.
Which of the follow arteries carries deoxygenated blood? a) Left coronary artery b) Left anterior descending artery c) Right coronary artery d) Pulmonary artery
d. Pulmonary artery Explanation: The pulmonary artery is the only artery carrying deoxygenated blood. Oxygenated blood returns to the left atrium via the pulmonary veins. The left coronary artery, right coronary artery, and left anterior descending artery do not carry deoxygenated blood.
The physician orders medication to treat a client's cardiac ischemia. The nurse is aware that which of the following is causing the client's condition? a) Indigestion b) Pain on exertion c) High blood pressure d) Reduced blood supply to the heart
d. Reduced blood supply to the heart Explanation: Ischemia is reduced blood supply to body organs. Cardiac ischemia is caused by reduced blood supply to the heart muscle. It may lead to a myocardial infarction. Chest pain is a symptom of ischemia. Ischemia is reduced blood supply to body organs. Ischemia is reduced blood supply to body organs.
