Random Cardiovascular
While analyzing a patient's EKG, the nurse notes that there are four small boxes from the beginning of the P wave to the beginning of the R wave. The PR interval is:
0.16 second
Antidote for Heparin:
Protamine Sulfate
The nurse is caring for a patient who had a myocardial infarction three days ago. The nurse should assess for which abnormal heart sound?
Pericardial friction rub
What should a nurse do to decrease or control the sensory and cognitive disturbances that can occur after a client has open heart surgery?
Plan for maximum periods of rest
Serum cardiac marker studies are prescribed for a client after a myocardial infarction. Which laboratory test is most important for the nurse to monitor because it has the greatest sensitivity and specificity for myocardial injury?
Troponin
A patient is brought to the emergency department with complaints of chest pain radiating to the shoulder and shortness of breath. Which of the following lab tests is MOST IMPORTANT to obtain and evaluate?
Troponin-I
A client who is scheduled for a modified radical mastectomy decides to have family members donate blood in the event it is needed. The client has type A negative blood. Blood can be used from relatives whose blood is:
Type A or O negative
Antidote for Coumadin:
Vitamin K
A nurse is teaching a client with Hodgkin disease about responses to whole-body radiation. Which clinical indicator increase should the nurse include?
Susceptibility to infection
Postoperatively, a client asks, "Could I have a pillow under my knees? My legs feel stretched." The nurse can best reinforce the preoperative teaching by responding:
"A pillow under the knees can result in clot formation because it slows blood flow."
A client with hypertension is to follow a 2-gram sodium diet. Which client statement provides evidence that the nurse's dietary instructions are understood?
"Labels on prepackaged food products should be evaluated before purchase."
A male client with aortic stenosis is scheduled for a valve replacement in 2 days. He tells the nurse, "I told my wife all she needs to know if I don't make it." What response is most therapeutic?
"You are worried about dying."
Side effects of B-blockers:
-headache -bradycardia -exercise difficulties -hypotension -depression -bronchoconstriction (caution with asthma and COPD)
Electrolyte imbalances that are common causes of ventricular tachycardia:
-hypomagnesium (low magnesium) -hyperkalemia (high potassium) -hypokalemia (low potassium)
Atenolol
-A beta blocker, slows the rate of SA node discharge and AV node conduction, thus decreasing the heart rate -Associated with the adverse reactions of bradycardia, heart failure, and pulmonary edema
IVC Filter
-A vascular filter that is implanted in the inferior vena cava and used to trap emboli floating in the vena cava -These filters can be temporary or permanent -It helps prevent pulmonary emboli by preventing any circulating clots from traveling to the lungs
Nurses can expect which of the following interventions to help regulate or treat patients with atrial flutter?
-Administer a non-dihydrophyridine calcium channel blocker or a beta blocker as ordered -Administer heparin as ordered -Cardioversion -Give ibutilide intravenously as ordered -Prepare the client for a radiofrequency catheter ablation
Atropine
-Anticholinergic and parasympatholytic -It increases cardiac output and heart rate by blocking the vagus nerve stimulation the heart -Indicated in severe bradycardia
Calcium Channel Blockers Nursing Implications:
-Assess blood pressure and pulse prior to giving, assess for peripheral edema
Nursing Implications for B-blockers:
-Assessing apical pulse and BP prior to administration -If HR is <50bpm the medications may be held and the provider notified
Patient teaching for a client scheduled for a cardiac catheterization via the femoral approach:
-Bed rest with the leg extended prevents trauma caused by hip flexion and provides time for the insertion site to heal -With the femoral approach, bed rest is maintained for several hours -Mild sedation is used for adult clients -The client is conscious -Post procedural dietary restrictions are minimal, if any
The nurse provides discharge teaching to a client with a history of angina. The nurse instructs the client to call for emergency services immediately if the client's pain:
-Continues after rest and nitroglycerin Rationale: When neither rest nor nitroglycerin relieves the pain, the client may be experiencing an acute myocardial infarction
The nurse is caring for a client that admitted with the diagnosis of mild chronic heart failure. The nurse expects to hear what sounds?
-Crackles Rationale: Left-sided heart failure causes fluid accumulation in the capillary network of the lungs; fluid eventually enters alveolar spaces and causes crackling sounds at the end of inspiration.
The occurrence of which condition would warrant the nurse calling the primary health care provider to discontinue the IV fluids?
-Crackles in lungs Rationale: Crackles in lungs indicates the client is overloaded with fluids. The nurse should notify the primary health care provider to discontinue the IV fluid
Diagnostic tests for DVT:
-D-dimer to confirm the presence of fibrin degradation products from a clot -Venous ultrasound -Venography to visualize the clot with contrast -MRI or CT (less common) *(Homans' sign was once used as a diagnostic tool for DVTs but is no longer recommended because of its poor predictive value. The risk of dislodging the clot when using Homans sign is not based on any clinical evidence)
Pharmacological treatment for tachycardia:
-Diltiazem (Cardizem) -Verapamil (Calan)
A nurse is evaluating the results of treatment with erythropoietin (Epogen). Which client response is considered significant?
-Elevation in hematocrit level Rationale: Erythropoietin stimulates red blood cell production, thereby elevating hematocrit levels.
Fat-Soluble Vitamin K
-Essential for synthesis of prothrombin by the liver -A lack results in hypothrombinemia, inadequate coagulation, and hemorrhage
Standard Nursing Interventions for a Myocardial Infarction (MI):
-administration of nitroglycerin and morphine -placement of cardiac monitor -administrations of oxygen -IV catheter insertion -provide patient with water
During a yearly physical examination a CBC is performed to determine a client's hematologic status. The nurse recalls that the CBC is composed of several tests, one of which is the level of:
-Hemoglobin (Hb) Rationale: A CBC includes RBC count and RBC indices, WBC count and WBC differential count, Hb, Hct, and platelet count.
Troponin-I
-Highly specific for cardiac muscle necrosis and is the MOST accurate lab test for myocardial infarctions -It rises in 3-4 hours and can be detected for up to 10-14 days
"Vagal Maneuvers"
-Includes bearing down as in a bowel movement and holding breath, gagging, and coughing -These stimulate the vagus nerve and slow the heart rate
Myocarditis
-Inflammation of the myocardium (the muscle of the heart) -Most often caused by viral infections but may also be caused by an autoimmune reaction to drugs or pathogens
Pericarditis
-Inflammation of the pericardium caused by infections, autoimmune disorders, or trauma -Instructing the patient to lean forward will pull the heart away from the lungs, preventing pericardial irritation caused by friction and contact with the lungs
Calcium Channel Blockers
-Inhibits calcium from entering the slow channels during depolarization -Used to manage angina and HTN -(PINEs)
Hypovolemic Shock
-Occurs when an abdominal aneurysm ruptures -Shock ensues because fluid volume becomes depleted as the heart continues to pump blood out of the ruptured vessel
Pericardial Friction Rub
-Often occurs within one week of having a myocardial infarction due to inflammation of the pericardial sac -It sounds like squeaky leather
Sublingual Nitroglycerin Tablets
-Onset of action is rapid (1-3 minutes) -Duration of action is 30-60 minutes -If nitroglycerin is administered intravenously, the onset of action is immediate and the duration is 3-5 minutes
The nurse is caring for a patient that suffered from a myocardial infarction. While monitoring the patient's EKG, the nurse may observe which of the following?
-Pathological Q-wave -ST elevation -T-wave inversion
Diagnostic studies for valvular heart disease:
-Patient's history/physical exam -CT scan of chest -Echocardiogram -Chest x-ray -ECG -Cardiac catheterization
Calcium Channel Blockers Side Effects:
-Peripheral edema -Hypotension -Constipation
Apical Pulse
-Point of maximal impact (PMI) -5th intercostal space, left sternal border
A nurse is caring for a client who is receiving aspirin therapy. Which clinical indicator related to this therapy should be a matter of concern to the nurse?
-Prolonged bleeding time Rationale: Aspiring interferes with platelet aggregation, thereby lengthening bleeding time. Urate excretion is enhanced by high doses of aspirin. Aspiring does not cause atrophy of the liver; it is readily broken down in the gastrointestinal tract and liver. Aspirin does not destroy erythrocytes.
Exercise Electrocardiogram
-This test evaluates the heart's ability to meet the need for additional oxygen in response to the stress of exercising. -Changes in the ECG identify dysrhythmias and ST changes indicative of myocardial ischemia -This test assists in the differential diagnosis of chest pain -This is a noninvasive test
A client is admitted with the diagnosis of possible myocardial infarction, and a series of diagnostic tests are prescribed. Which blood level should the nurse expect will increase first if this client has had a myocardial infarction?
-Troponin T (cTnT) Rationale: Troponin T has an extraordinarily high specificity for myocardial cell injury. Cardiac troponins elevate sooner and remain elevated longer than many of the other enzymes that reflect myocardial injury.
A nurse is obtaining an admission history for a client who is scheduled for surgery to repair a ruptured abdominal aneurysm. Which type of shock is this client at risk for developing?
Hypovolemic
A client is seen in the clinic with sickle cell anemia. A brief explanation for this condition is:
Abnormally shaped red blood cells
Creatine kinase-MB band (CK-MB)
An isoenzyme of creatine phosphokinase (CPK) found in cardiac muscle; it increases in 4-6 hours after chest pain and begins to decline in 12-24 hours
The nurse concludes that the gradual occlusion of the internal or common carotid arteries, manifested by transient ischemic attacks, may occur because of:
Atherosclerosis of the vascular system
A client is diagnosed with pancytopenia caused by chemotherapy. What should a nurse teach the client about this complication?
Avoid traumatic injury and exposure to infection
Gold standard for evaluating aortic disorders:
CT scan of the chest with contrast
The nurse observes a client collapse whiles walking down the hallway. What will the nurse do first?
Check for a carotid pulse
Within 4-6 hours after a client has a myocardial infarction, the nurse expects which blood level to increase?
Creatine kinase-MB band (CK-MB)
Cardiac Catheterization
Detects pressure changes in the cardiac chambers, records pressure difference across the valves, and measures the size of valve openings
To prevent thrombus formation after most surgeries, the nurse should plan to:
Encourage the client to ambulate with assistance every few hours
A client with a history of heart failure and atrial fibrillation reports a nine-pound weight gain in the last two weeks. The nurse interprets that the most likely cause of this sudden weight gain is:
Fluid retention
Most common side effect of nitroglycerin:
Headache (Other cardiovascular side effects include: tachycardia, hypotension, and dizziness)
Nursing interventions for patient with DVT:
Heat, pain medication, and elevation of the leg *(Ambulation does not increase the risk of developing PE in patients with a DVT, but the current recommendation is still to rest the affected limb and avoid ambulating during recovery)
A client is in the intensive care unit. The nurse observing the telemetry monitor identifies flattening T waves and peaked P waves. What problem should the nurse consider based on these ECG changes?
Hypokalemia
ECG
Identifies heart rate, rhythm, and any ischemia or ventricular hypertrophy
A client is recovering from a myocardial infarction. Before developing the client's teaching plan, it is important for the nurse to:
Identify the learning needs of the client
The nurse is caring for a client who is experiencing signs and symptoms of a cardiac dysrhythmia who is scheduled to wear a Holter monitor for 24 hours. During the test, the client should be instructed to:
Keep a diary of activities
The nurse is caring for a patient complaining of chest pain related to pericarditis. To help relieve the pain, the nurse should instruct the patient to:
Lean forward while sitting
A client is diagnosed with hypertension that is related to atherosclerosis. The nurse recalls that with atherosclerosis:
Lipid Plaque formation occurs within the arterial vessels.
A client with a cardiac dysrythmia is receiving digoxin (Lanoxin) and verapamil (Calan). Because of the combined effect of these two medications, the nurse assesses the client for:
Myocardial Depression
A client who had surgery 24 hours ago reports pain in the calf. Assessment reveals redness and swelling at the site of discomfort. What should the nurse do?
Notify the health care provider
Intermittent Claudication
Pain that results when the arterial system is unable to provide adequate blood flow to the tissues in the presence of increased demands for oxygen and nutrients during exercise; it is relieved by rest
Chest X-Ray
Reveals heart size, altered pulmonary circulation, and valve calcification
Echocardiogram
Reveals valve structure, function, and heart chamber size
A change in which component of the ECG tracing should the nurse recognize as the client actively having a myocardial infarction (MI)?
S-T segment Rationale: A displacement of the S-T segment is caused by an active ischemic injury in the myocardium
Before a client has a cardiac catheterization, an ECG is performed and hypokalemia is suspected. The nurse expects that the diagnosis will be confirmed by which diagnostic test?
Serum potassium level
The physician prescribes one unit of packed red blood cells to be administered to a client. To ensure the client's safety, which measure should the nurse take during administration of blood products?
Stay with client during first 15 minutes of infusion
The nurse is preparing a patient for a pericardiocentesis for the treatment of cardiac tamponade. How should the patient be positioned?
Supine with the head of the bed at 45 degrees Rationale: This allows for easier insertion of the needle under the xiphoid process into the pericardial sac