Test 1 Practice
Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation? A Beta-adrenergic blockers B Calcium channel blockers C Narcotics D Nitrates
A Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing myocardial oxygen demand. Calcium channel blockers reduce the workload of the heart by decreasing the heart rate. Narcotics reduce myocardial oxygen demand, promote vasodilation, and decrease anxiety. Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure (preload) and systemic vascular resistance (afterload).
The antagonist for magnesium sulfate should be readily available to any client receiving IV magnesium. Which of the following drugs is the antidote for magnesium toxicity? A Calcium gluconate B Hydralazine (Apresoline) C Narcan D RhoGAM
A Calcium gluconate is the antidote for magnesium toxicity. Ten ml of 10% calcium gluconate is given IV push over 3-5 minutes. Hydralazine is given for sustained elevated blood pressures in preeclamptic clients.
The physician orders continuous intravenous nitroglycerin infusion for the client with MI. Essential nursing actions include which of the following? A Obtaining an infusion pump for the medication B Monitoring BP q4h C Monitoring urine output hourly D Obtaining serum potassium levels daily
A IV nitro infusion requires an infusion pump for precise control of the medication. BP monitoring would be done with a continuous system, and more frequently than every 4 hours. Hourly urine outputs are not always required. Obtaining serum potassium levels is not associated with nitroglycerin infusion.
Furosemide is administered intravenously to a client with HF. How soon after administration should the nurse begin to see evidence of the drugs desired effect? A 5 to 10 minutes B 30 to 60 minutes C 2 to 4 hours D 6 to 8 hours
A After IV injection of furosemide, diuresis normally begins in about 5 minutes and reaches its peak within about 30 minutes. Medication effects last 2 to 4 hours.
Which of the following types of cardiomyopathy can be associated with childbirth? A Dilated B Hypertrophic C Myocarditis D Restrictive
A Although the cause isn't entirely known, cardiac dilation and heart failure may develop during the last month of pregnancy or the first few months after birth. The condition may result from a preexisting cardiomyopathy not apparent prior to pregnancy. Hypertrophic cardiomyopathy is an abnormal symmetry of the ventricles that has an unknown etiology but a strong familial tendency. Myocarditis isn't specifically associated with childbirth. Restrictive cardiomyopathy indicates constrictive pericarditis; the underlying cause is usually myocardial.
Which of the following heart muscle diseases is unrelated to other cardiovascular disease? A Cardiomyopathy B Coronary artery disease C Myocardial infarction D Pericardial effusion
A Cardiomyopathy isn't usually related to an underlying heart disease such as atherosclerosis. The etiology in most cases is unknown. CAD and MI are directly related to atherosclerosis. Pericardial effusion is the escape of fluid into the pericardial sac, a condition associated with Pericarditis and advanced heart failure.
A maternity nurse is caring for a client with abruptio placenta and is monitoring the client for disseminated intravascular coagulopathy. Which assessment finding is least likely to be associated with disseminated intravascular coagulation? A Swelling of the calf in one leg B Prolonged clotting times C Decreased platelet count D Petechiae, oozing from injection sites, and hematuria
A DIC is a state of diffuse clotting in which clotting factors are consumed, leading to widespread bleeding. Platelets are decreased because they are consumed by the process; coagulation studies show no clot formation (and are thus normal to prolonged); and fibrin plugs may clog the microvasculature diffusely, rather than in an isolated area. The presence of petechiae, oozing from injection sites, and hematuria are signs associated with DIC. Swelling and pain in the calf of one leg are more likely to be associated with thrombophlebitis.
A client admitted with angina complains of severe chest pain and suddenly becomes unresponsive. After establishing unresponsiveness, which of the following actions should the nurse take first? A Activate the resuscitation team B Open the client's airway C Check for breathing D Check for signs of circulation
A Immediately after establishing unresponsiveness, the nurse should activate the resuscitation team. The next step is to open the airway using the head-tilt, chin-lift maneuver and check for breathing (looking, listening, and feeling for no more than 10-seconds). If the client isn't breathing, give two slow breaths using a bag mask or pocket mask. Next, check for signs of circulation by palpating the carotid pulse.
An older, sedentary adult may not respond to emotional or physical stress as well as a younger individual because of: A Left ventricular atrophy B Irregular heartbeats C Peripheral vascular occlusion D Pacemaker placement
A In older adults who are less active and do not exercise the heart muscle, atrophy can result. Disuse or deconditioning can lead to abnormal changes in the myocardium of the older adult. As a result, under sudden emotional or physical stress, the left ventricle is less able to respond to the increased demands on the myocardial muscle.
Toxicity from which of the following medications may cause a client to see a green-yellow halo around lights? A Digoxin B Furosemide (Lasix) C Metoprolol (Lopressor) D Enalapril (Vasotec)
A One of the most common signs of digoxin toxicity is the visual disturbance known as the "green-yellow halo sign." The other medications aren't associated with such an effect.
Which of the following complications is indicated by a third heart sound (S3)? A Ventricular dilation B Systemic hypertension C Aortic valve malfunction D Increased atrial contractions
A Rapid filling of the ventricle causes vasodilation that is auscultated as S3. Increased atrial contraction or systemic hypertension can result in a fourth heart sound. Aortic valve malfunction is heard as a murmur.
Which of the following results is the primary treatment goal for angina? A Reversal of ischemia B Reversal of infarction C Reduction of stress and anxiety D Reduction of associated risk factors
A Reversal of the ischemia is the primary goal, achieved by reducing oxygen consumption and increasing oxygen supply. An infarction is permanent and can't be reversed.
Which of the following nursing diagnoses would be appropriate for a client with heart failure? Select all that apply. A Ineffective tissue perfusion related to decreased peripheral blood flow secondary to decreased cardiac output. B Activity intolerance related to increased cardiac output. C Decreased cardiac output related to structural and functional changes. D Impaired gas exchange related to decreased sympathetic nervous system activity.
A, C HF is a result of structural and functional abnormalities of the heart tissue muscle. The heart muscle becomes weak and does not adequately pump the blood out of the chambers. As a result, blood pools in the left ventricle and backs up into the left atrium, and eventually into the lungs. Therefore, greater amounts of blood remain in the ventricle after contraction thereby decreasing cardiac output. In addition, this pooling leads to thrombus formation and ineffective tissue perfusion because of the decrease in blood flow to the other organs and tissues of the body. Typically, these clients have an ejection fraction of less than 50% and poorly tolerate activity. Activity intolerance is related to a decrease, not increase, in cardiac output. Gas exchange is impaired. However, the decrease in cardiac output triggers compensatory mechanisms, such as an increase in sympathetic nervous system activity.
A nurse is monitoring a pregnant client with pregnancy induced hypertension who is at risk for Preeclampsia. The nurse checks the client for which specific signs of Preeclampsia (select all that apply)? A Elevated blood pressure B Negative urinary protein C Facial edema D Increased respirations
A, C The three classic signs of preeclampsia are hypertension, generalized edema, and proteinuria. Increased respirations are not a sign of preeclampsia.
Tissue plasminogen activator (t-PA) is considered for treatment of a patient who arrives in the emergency department following onset of symptoms of myocardial infarction. Which of the following is a contraindication for treatment with t-PA? A Worsening chest pain that began earlier in the evening. B History of cerebral hemorrhage. C History of prior myocardial infarction. D Hypertension.
B A history of cerebral hemorrhage is a contraindication to tPA because it may increase the risk of bleeding. TPA acts by dissolving the clot blocking the coronary artery and works best when administered within 6 hours of onset of symptoms. Prior MI is not a contraindication to tPA. Patients receiving tPA should be observed for changes in blood pressure, as tPA may cause hypotension.
What is the first intervention for a client experiencing MI? A Administer morphine B Administer oxygen C Administer sublingual nitroglycerin D Obtain an ECG
B Administering supplemental oxygen to the client is the first priority of care. The myocardium is deprived of oxygen during an infarction, so additional oxygen is administered to assist in oxygenation and prevent further damage. Morphine and nitro are also used to treat MI, but they're more commonly administered after the oxygen. An ECG is the most common diagnostic tool used to evaluate MI.
A nurse is preparing to ambulate a client on the 3rd day after cardiac surgery. The nurse would plan to do which of the following to enable the client to best tolerate the ambulation? A Encourage the client to cough and deep breathe B Premedicate the client with an analgesic C Provide the client with a walker D Remove telemetry equipment because it weighs down the hospital gown
B The nurse should encourage regular use of pain medication for the first 48 to 72 hours after cardiac surgery because analgesia will promote rest, decrease myocardial oxygen consumption resulting from pain, and allow better participation in activities such as coughing, deep breathing, and ambulation. Options 1 and 3 will not help in tolerating ambulation. Removal of telemetry equipment is contraindicated unless prescribed.
Aspirin is administered to the client experiencing an MI because of its: A Antipyretic action B Antithrombotic action C Antiplatelet action D Analgesic action
B Aspirin does have antipyretic, antiplatelet, and analgesic actions, but the primary reason ASA is administered to the client experiencing an MI is its antithrombotic action.
Which of the following classes of drugs is most widely used in the treatment of cardiomyopathy? A Antihypertensives B Beta-adrenergic blockers C Calcium channel blockers D Nitrates
B By decreasing the heart rate and contractility, beta-blockers improve myocardial filling and cardiac output, which are primary goals in the treatment of cardiomyopathy. Antihypertensives aren't usually indicated because they would decrease cardiac output in clients who are already hypotensive. Calcium channel blockers are sometimes used for the same reasons as beta-blockers; however, they aren't as effective as beta-blockers and cause increased hypotension. Nitrates aren't used because of their dilating effects, which would further compromise the myocardium.
In which of the following types of cardiomyopathy does cardiac output remain normal? A Dilated B Hypertrophic C Obliterative D Restrictive
B Cardiac output isn't affected by hypertrophic cardiomyopathy because the size of the ventricle remains relatively unchanged. All of the rest decrease cardiac output.
A 55-year-old client is admitted with an acute inferior-wall myocardial infarction. During the admission interview, he says he stopped taking his metoprolol (Lopressor) 5 days ago because he was feeling better. Which of the following nursing diagnoses takes priority for this client? A Anxiety B Ineffective tissue perfusion; cardiopulmonary C Acute pain D Ineffective therapeutic regimen management
B MI results from prolonged myocardial ischemia caused by reduced blood flow through the coronary arteries. Therefore, the priority nursing diagnosis for this client is Ineffective tissue perfusion (cardiopulmonary). Anxiety, acute pain, and ineffective therapeutic regimen management are appropriate but don't take priority.
Medical treatment of coronary artery disease includes which of the following procedures? A Coronary artery bypass surgery B Oral medication therapy C Percutaneous transluminal coronary angioplasty
B Oral medication administration is a noninvasive, medical treatment for coronary artery disease. Cardiac catherization isn't a treatment, but a diagnostic tool. Coronary artery bypass surgery and percutaneous transluminal coronary angioplasty are invasive, surgical treatments.
Which of the following actions is the first priority of care for a client exhibiting signs and symptoms of coronary artery disease? A Decrease anxiety B Enhance myocardial oxygenation C Administer sublingual nitroglycerin D Educate the client about his symptoms
B Question 1 Explanation: Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of cardiac compromise. Without adequate oxygenation, the myocardium suffers damage. Sublingual nitroglycerin is administered to treat acute angina, but administration isn't the first priority. Although educating the client and decreasing anxiety are important in care delivery, neither are priorities when a client is compromised.
Which of the following reflects the principle on which a client's diet will most likely be based during the acute phase of MI? A Liquids as ordered B Small, easily digested meals C Three regular meals per day D NPO
B Recommended dietary principles in the acute phase of MI include avoiding large meals because small, easily digested foods are better digested foods are better tolerated. Fluids are given according to the client's needs, and sodium restrictions may be prescribed, especially for clients with manifestations of heart failure. Cholesterol restrictions may be ordered as well. Clients are not prescribed a diet of liquids only or NPO unless their condition is very unstable.
Stimulation of the sympathetic nervous system produces which of the following responses? A Bradycardia B Tachycardia C Hypotension D Decreased myocardial contractility
B Stimulation of the sympathetic nervous system causes tachycardia and increased contractility. The other symptoms listed are related to the parasympathetic nervous system, which is responsible for slowing the heart rate.
A home care nurse is making a routine visit to a client receiving digoxin (Lanoxin) in the treatment of heart failure. The nurse would particularly assess the client for: A Thrombocytopenia and weight gain B Anorexia, nausea, and visual disturbances C Diarrhea and hypotension D Fatigue and muscle twitching
B The first signs and symptoms of digoxin toxicity in adults include abdominal pain, N/V, visual disturbances (blurred, yellow, or green vision, halos around lights), bradycardia, and other dysrhythmias.
Following myocardial infarction, a hospitalized patient is encouraged to practice frequent leg exercises and ambulate in the hallway as directed by his physician. Which of the following choices reflects the purpose of exercise for this patient? A Increases fitness and prevents future heart attacks. B Prevents bedsores. C Prevents DVT (deep vein thrombosis). D Prevent constipations.
C Exercise is important for all hospitalized patients to prevent deep vein thrombosis. Muscular contraction promotes venous return and prevents hemostasis in the lower extremities. This exercise is not sufficiently vigorous to increase physical fitness, nor is it intended to prevent bedsores or constipation.
Captopril may be administered to a client with HF because it acts as a: A Vasopressor B Volume expander C Vasodilator D Potassium-sparing diuretic
C ACE inhibitors have become the vasodilators of choice in the client with mild to severe HF. Vasodilator drugs are the only class of drugs clearly shown to improve survival in overt heart failure.
What is the most common complication of an MI? A Cardiogenic shock B Heart failure C Arrhythmias D Pericarditis
C Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI. Cardiogenic shock, another complication of an MI, is defined as the end stage of left ventricular dysfunction. This condition occurs in approximately 15% of clients with MI. Because the pumping function of the heart is compromised by an MI, heart failure is the second most common complication. Pericarditis most commonly results from a bacterial or viral infection but may occur after the MI.
Which of the following conditions is most commonly responsible for myocardial infarction? A Aneurysm B Heart failure C Coronary artery thrombosis D Renal failure
C Coronary artery thrombosis causes an inclusion of the artery, leading to myocardial death. An aneurysm is an outpouching of a vessel and doesn't cause an MI. Renal failure can be associated with MI but isn't a direct cause. Heart failure is usually a result from an MI.
A homecare nurse visits a pregnant client who has a diagnosis of mild Preeclampsia and who is being monitored for pregnancy induced hypertension (PIH). Which assessment finding indicates a worsening of the Preeclampsia and the need to notify the physician? A Blood pressure reading is at the prenatal baseline B Urinary output has increased C The client complains of a headache and blurred vision D Dependent edema has resolved
C If the client complains of a headache and blurred vision, the physician should be notified because these are signs of worsening Preeclampsia.
A primigravida is receiving magnesium sulfate for the treatment of pregnancy induced hypertension (PIH). The nurse who is caring for the client is performing assessments every 30 minutes. Which assessment finding would be of most concern to the nurse? A Urinary output of 20 ml since the previous assessment B Deep tendon reflexes of 2+ C Respiratory rate of 10 BPM D Fetal heart rate of 120 BPM
C Magnesium sulfate depresses the respiratory rate. If the respiratory rate is less than 12 breaths per minute, the physician or other health care provider needs to be notified, and continuation of the medication needs to be reassessed. A urinary output of 20 ml in a 30 minute period is adequate; less than 30 ml in one hour needs to be reported. Deep tendon reflexes of 2+ are normal. The fetal heart rate is WNL for a resting fetus.
A nurse is caring for a pregnant client with Preeclampsia. The nurse prepares a plan of care for the client and documents in the plan that if the client progresses from Preeclampsia to eclampsia, the nurse's first action is to: A Administer magnesium sulfate intravenously B Assess the blood pressure and fetal heart rate C Clean and maintain an open airway D Administer oxygen by face mask
C The immediate care during a seizure (eclampsia) is to ensure a patent airway. The other options are actions that follow or will be implemented after the seizure has ceased.
If medical treatments fail, which of the following invasive procedures is necessary for treating cardiomyopathy? A Cardiac catheterization B Coronary artery bypass graft (CABG) C Heart transplantation D Intra-aortic balloon pump (IABP)
C The only definitive treatment for cardiomyopathy that can't be controlled medically is a heart transplant because the damage to the heart muscle is irreversible.
Which of the following blood tests is most indicative of cardiac damage? A Lactate dehydrogenase B Complete blood count (CBC) C Troponin I D Creatine kinase (CK)
C Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin I levels aren't detectable in people without cardiac injury. Lactate dehydrogenase (LDH) is present in almost all body tissues and not specific to heart muscle. LDH isoenzymes are useful in diagnosing cardiac injury. CBC is obtained to review blood counts, and a complete chemistry is obtained to review electrolytes. Because CK levels may rise with skeletal muscle injury, CK isoenzymes are required to detect cardiac injury.
A woman with preeclampsia is receiving magnesium sulfate. The nurse assigned to care for the client determines that the magnesium therapy is effective if: A Ankle clonus in noted B The blood pressure decreases C Seizures do not occur D Scotomas are present
C For a client with preeclampsia, the goal of care is directed at preventing eclampsia (seizures). Magnesium sulfate is an anticonvulsant, not an antihypertensive agent. Although a decrease in blood pressure may be noted initially, this effect is usually transient. Ankle clonus indicated hyperreflexia and may precede the onset of eclampsia. Scotomas are areas of complete or partial blindness. Visual disturbances, such as scotomas, often precede an eclamptic seizure.
A nurse is caring for a pregnant client with severe preeclampsia who is receiving IV magnesium sulfate. Select all nursing interventions that apply in the care for the client. A Monitor maternal vital signs every 2 hours B Notify the physician if respirations are less than 18 per minute. C Monitor renal function and cardiac function closely D Keep calcium gluconate on hand in case of a magnesium sulfate overdose E Monitor deep tendon reflexes hourly F Monitor I and O's hourly G Notify the physician if urinary output is less than 30 ml per hour.
C, D, E, F, G When caring for a client receiving magnesium sulfate therapy, the nurse would monitor maternal vital signs, especially respirations, every 30-60 minutes and notify the physician if respirations are less than 12, because this would indicate respiratory depression. Calcium gluconate is kept on hand in case of magnesium sulfate overdose, because calcium gluconate is the antidote for magnesium sulfate toxicity. Deep tendon reflexes are assessed hourly. Cardiac and renal function is monitored closely. The urine output should be maintained at 30 ml per hour because the medication is eliminated through the kidneys.
Which of the following cardiac conditions does a fourth heart sound (S4) indicate? A Dilated aorta B Normally functioning heart C Decreased myocardial contractility D Failure of the ventricle to eject all of the blood during systole
D An S4 occurs as a result of increased resistance to ventricular filling after atrial contraction. The increased resistance is related to decreased compliance of the ventricle. A dilated aorta doesn't cause an extra heart sound, though it does cause a murmur. Decreased myocardial contractility is heard as a third heart sound. An S4 isn't heard in a normally functioning heart.
Which of the following is an expected outcome for a client on the second day of hospitalization after an MI? A Has severe chest pain B Can identify risks factors for MI C Agrees to participate in a cardiac rehabilitation walking program D Can perform personal self-care activities without pain
D By day 2 of hospitalization after an MI, clients are expected to be able to perform personal care without chest pain. Day 2 hospitalization may be too soon for clients to be able to identify risk factors for MI or begin a walking program; however, the client may be sitting up in a chair as part of the cardiac rehabilitation program. Severe chest pain should not be present.
A patient arrives in the emergency department with symptoms of myocardial infarction, progressing to cardiogenic shock. Which of the following symptoms should the nurse expect the patient to exhibit with cardiogenic shock? A Hypertension. B Bradycardia. C Bounding pulse. D Confusion
D Cardiogenic shock severely impairs the pumping function of the heart muscle, causing diminished blood flow to the organs of the body. This results in diminished brain function and confusion, as well as hypotension, tachycardia, and weak pulse. Cardiogenic shock is a serious complication of myocardial infarction with a high mortality rate.
What is the primary reason for administering morphine to a client with an MI? A To sedate the client B To decrease the client's pain C To decrease the client's anxiety D To decrease oxygen demand on the client's heart
D Morphine is administered because it decreases myocardial oxygen demand. Morphine will also decrease pain and anxiety while causing sedation, but it isn't primarily given for those reasons.
Which of the following symptoms is the most likely origin of pain the client described as knifelike chest pain that increases in intensity with inspiration? A Cardiac B Gastrointestinal C Musculoskeletal D Pulmonary
D Pulmonary pain is generally described by these symptoms. Musculoskeletal pain only increases with movement. Cardiac and GI pains don't change with respiration.
Which of the following tests is used most often to diagnose angina? A Chest x-ray B Echocardiogram C Cardiac catheterization D 12-lead electrocardiogram (ECG)
D The 12-lead ECG will indicate ischemia, showing T-wave inversion. In addition, with variant angina, the ECG shows ST-segment elevation. A chest x-ray will show heart enlargement or signs of heart failure, but isn't used to diagnose angina.
A client who had cardiac surgery 24 hours ago has a urine output averaging 19 ml/hr for 2 hours. The client received a single bolus of 500 ml of IV fluid. Urine output for the subsequent hour was 25 ml. Daily laboratory results indicate the blood urea nitrogen is 45 mg/dL and the serum creatinine is 2.2 mg/dL. A nurse interprets the client is at risk for: A Hypovolemia B UTI C Glomerulonephritis D Acute renal failure
D The client who undergoes cardiac surgery is at risk for renal injury from poor perfusion, hemolysis, low cardiac output, or vasopressor medication therapy. Renal insult is signaled by decreased urine output, and increased BUN and creatinine levels. The client may need medications such as dopamine (Intropin) to increase renal perfusion and possibly could need peritoneal dialysis or hemodialysis.
The nurse coming on duty receives the report from the nurse going off duty. Which of the following clients should the on-duty nurse assess first? A The 58-year-old client who was admitted 2 days ago with heart failure, BP of 126/76, and a respiratory rate of 21 breaths a minute. B The 88-year-old client with end-stage right-sided heart failure, BP of 78/50, and a DNR order. C The 62-year-old client who was admitted one day ago with thrombophlebitis and receiving IV heparin. D A 76-year-old client who was admitted 1 hour ago with new-onset atrial fibrillation and is receiving IV diltiazem (Cardizem).
D The client with A-fib has the greatest potential to become unstable and is on IV medication that requires close monitoring. After assessing this client, the nurse should assess the client with thrombophlebitis who is receiving a heparin infusion, and then go to the 58-year-old client admitted 2-days ago with heart failure (her s/s are resolving and don't require immediate attention). The lowest priority is the 89-year-old with end stage right-sided heart failure, who requires time consuming supportive measures.
Which of the following types of angina is most closely related with an impending MI? A Angina decubitus B Chronic stable angina C Nocturnal angina D Unstable angina
D Unstable angina progressively increases in frequency, intensity, and duration and is related to an increased risk of MI within 3 to 18 months.
A client has frequent bursts of ventricular tachycardia on the cardiac monitor. A nurse is most concerned with this dysrhythmia because: A It is uncomfortable for the client, giving a sense of impending doom. B It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia. C It is almost impossible to convert to a normal sinus rhythm. D It can develop into ventricular fibrillation at any time.
D Ventricular tachycardia is a life-threatening dysrhythmia that results from an irritable ectopic focus that takes over as the pacemaker for the heart. The low cardiac output that results can lead quickly to cerebral and myocardial ischemia. Client's frequently experience a feeling of impending death. Ventricular tachycardia is treated with antiarrhythmic medications or magnesium sulfate, cardioversion (client awake), or defibrillation (loss of consciousness), Ventricular tachycardia can deteriorate into ventricular fibrillation at any time.
A pregnant client is receiving magnesium sulfate for the management of preeclampsia. A nurse determines the client is experiencing toxicity from the medication if which of the following is noted on assessment? A Presence of deep tendon reflexes B Serum magnesium level of 6 mEq/L C Proteinuria of +3 D Respirations of 10 per minute
D Magnesium toxicity can occur from magnesium sulfate therapy. Signs of toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression, loss of deep tendon reflexes, and a sudden drop in the fetal heart rate and maternal heart rate and blood pressure. Therapeutic levels of magnesium are 4-7 mEq/L. Proteinuria of +3 would be noted in a client with preeclampsia.
After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation of crackles in the lungs? A Left-sided heart failure B Pulmonic valve malfunction C Right-sided heart failure D Tricupsid valve malfunction
A The left ventricle is responsible for most of the cardiac output. An anterior wall MI may result in a decrease in left ventricular function. When the left ventricle doesn't function properly, resulting in left-sided heart failure, fluid accumulates in the interstitial and alveolar spaces in the lungs and causes crackles. Pulmonic and tricuspid valve malfunction causes right sided heart failure.
Which of the following would be a priority nursing diagnosis for the client with heart failure and pulmonary edema? A Risk for infection related to stasis of alveolar secretions B Impaired skin integrity related to pressure C Activity intolerance related to pump failure D Constipation related to immobility
C Activity intolerance is a primary problem for clients with heart failure and pulmonary edema. The decreased cardiac output associated with heart failure leads to reduced oxygen and fatigue. Clients frequently complain of dyspnea and fatigue. The client could be at risk for infection related to stasis of secretions or impaired skin integrity related to pressure. However, these are not the priority nursing diagnoses for the client with HF and pulmonary edema, nor is constipation related to immobility.
Myocardial oxygen consumption increases as which of the following parameters increase? A Preload, afterload, and cerebral blood flow B Preload, afterload, and renal blood flow c Preload, afterload, contractility, and heart rate D Preload, afterload, cerebral blood flow, and heart rate.
c Myocardial oxygen consumption increases as preload, afterload, renal contractility, and heart rate increase. Cerebral blood flow doesn't directly affect myocardial oxygen consumption.
Which of the following is a compensatory response to decreased cardiac output? A Decreased BP b Alteration in LOC C Decreased BP and diuresis d Increased BP and fluid retention
d The body compensates for a decrease in cardiac output with a rise in BP, due to the stimulation of the sympathetic NS and an increase in blood volume as the kidneys retain sodium and water. Blood pressure doesn't initially drop in response to the compensatory mechanism of the body. Alteration in LOC will occur only if the decreased cardiac output persists.
Which of the following is the most common symptom of myocardial infarction (MI)? A Chest pain B Dyspnea C Edema D Palpitations
A
Which of the following recurring conditions most commonly occurs in clients with cardiomyopathy? A Heart failure B Diabetes C MI D Pericardial effusion
A Because the structure and function of the heart muscle is affected, heart failure most commonly occurs in clients with cardiomyopathy. MI results from prolonged myocardial ischemia due to reduced blood flow through one of the coronary arteries. Pericardial effusion is most predominant in clients with pericarditis.
A pregnant client in the last trimester has been admitted to the hospital with a diagnosis of severe preeclampsia. A nurse monitors for complications associated with the diagnosis and assesses the client for: A Any bleeding, such as in the gums, petechiae, and purpura. B Enlargement of the breasts C Periods of fetal movement followed by quiet periods D Complaints of feeling hot when the room is cool
A Severe Preeclampsia can trigger disseminated intravascular coagulation because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and should be reported to the M.D.
Septal involvement occurs in which type of cardiomyopathy? A Congestive B Dilated C Hypertrophic D Restrictive
C In hypertrophic cardiomyopathy, hypertrophy of the ventricular septum—not the ventricle chambers—is apparent. This abnormality isn't seen in other types of cardiomyopathy.
Which of the following classes of medications maximizes cardiac performance in clients with heart failure by increasing ventricular contractility? A Beta-adrenergic blockers B Calcium channel blockers C Diuretics D Inotropic agents
D Inotropic agents are administered to increase the force of the heart's contractions, thereby increasing ventricular contractility and ultimately increasing cardiac output.
