test 2

The nurse provides information about angioplasty treatment to a group of student nurses. Which statement made by a student nurse indicates the need for further teaching? "Angioplasty is safe for a patient with unstable angina." "Patients can return to work more quickly after angioplasty than after coronary bypass surgery." "Angioplasty is considered to be a first line treatment for definitive electrocardiogram changes." "The most serious complication of angioplasty is dissection of the newly dilated coronary artery."

"Angioplasty is safe for a patient with unstable angina." Coronary angiography is considered safe for a patient with stable and controlled angina; however, it is not preferred in a patient with unstable angina. The patient can return to work more quickly after an angioplasty because it is an alternative to surgical interventions, such as coronary artery bypass surgery. Angioplasty is a first line treatment to a patient with confirmed myocardial infarction, definitive electrocardiogram changes, and positive cardiac markers. The most serious complication of angioplasty is dissection of the newly dilated coronary artery; this dissection may lead to coronary artery rupture. p. 751

The nurse is caring for a patient with hypercholesterolemia who is taking 20 mg of simvastatin [Zocor] as prescribed. After a few days, the patient's urinalysis reports indicated the presence of myoglobin. What instruction would the nurse receive from the primary healthcare provider? "Give 10 mg of medication daily." "Give the medication before meals." "Discontinue administering the medication." "Give the medication with 250 mL of water."

"Discontinue administering the medication." The presence of myoglobin in the urine indicates that the patient has rhabdomyolysis, an adverse effect of statins such as simvastatin [Zocor]. Rhabdomyolysis is characterized by the breakdown of muscle proteins and can be fatal. The primary healthcare provider would instruct the nurse to discontinue the medication. Reducing the dose of the medication to 10 mg, giving the medication before meals, or administering the medication with high amounts of fluids does not prevent rhabdomyolysis. p. 569

Which statement of the student nurse indicates the need for further teaching about postoperative interventions to be followed for a patient who has undergone an aortic aneurysm surgery? "I should administer sodium nitroprusside to the patient." "I should assess the patient's body temperature regularly." "I should administer a broad-spectrum antibiotic to the patient." "I should always keep an indwelling urinary catheter in the patient."

"I should always keep an indwelling urinary catheter in the patient." The early removal of an indwelling urinary catheter reduces the risk of a urinary tract infection. Sodium nitroprusside reduces high blood pressure and prevents rupture of the sutures. The nurse should assess the patient's body temperature regularly. Administering broad-spectrum antibiotics to the patient helps prevent risk of infection. p. 844

A patient with a newly inserted pacemaker receives discharge instructions. Which patient statement indicates that further teaching is required? "I should avoid using microwave ovens." "I should avoid standing near antitheft devices." "I should avoid direct blows to the pacemaker site." "I should avoid close proximity to high-output electric generators."

"I should avoid using microwave ovens." Microwaves do not interfere with a pacemaker's function and can be used safely. Electric signals from antitheft devices can affect pacemaker functioning. The patient should avoid direct blows to the pacemaker site to reduce pressure at the site. Electric signals from high-output electric generators can move the pacemaker from its position and affect its functioning. p. 806

Which statements by a patient with diabetes mellitus indicate a need for additional teaching about interventions to lower the risk of peripheral artery disease? "I should wear cotton socks." "I should refrain from soaking my feet." "I should refrain from measuring capillary refill." "I should inspect my feet daily for any mottling." "I should remove the hair on my feet on a regular basis."

"I should refrain from measuring capillary refill." "I should remove the hair on my feet on a regular basis." The patient with diabetes mellitus is at high risk for developing peripheral artery disease. The nurse should teach the diabetic patient to check capillary refill regularly to ensure he or she has proper blood circulation. The patient should check for hair growth on feet. However, the patient should not remove the hair regularly because it may interfere with assessment of hair growth. Wearing cotton socks protects and prevents infections. Refraining from soaking the feet will prevent skin maceration. Inspecting feet daily for mottling will help prevent further complications. p. 839

The nurse is teaching a patient with chronic stable angina on the use of nitroglycerin (NTG). Which statement made by the patient indicates effective learning? "I should dissolve the tablets in a glass of water." "I should store the medications in a light area." "I should replace the tablets in the container every 18 months." "I should take a tablet one half-hour before beginning activities."

"I should take a tablet one half-hour before beginning activities." Nitroglycerine is a first line treatment for patients with chronic stable angina. The patient should take nitroglycerin (NTG) before beginning any strenuous activities in order to prevent an anginal episode. The patient should keep nitroglycerin tablets away from light and heat sources to protect them from degradation. Therefore, the medication should be stored in a shady area. The patient should replace the tablets in the container every six months. p. 743

The nurse determines that the patient has understood the discharge teaching regarding warfarin [Coumadin] based on which of the patient's statements? "I should keep taking ibuprofen for my arthritis." "I should use a soft toothbrush for dental hygiene." "I should decrease the dose if I start bruising easily." "I will double my dose if I forget to take it the day before."

"I should use a soft toothbrush for dental hygiene." Using a soft-bristled toothbrush for dental hygiene will reduce the risk of bleeding. The patient should not double the dose of warfarin. Ibuprofen will potentiate bleeding. The patient should call the healthcare provider if experiencing excessive bruising. p. 605

Which statement made by the patient indicates to the nurse that understanding of the discharge instructions on antihyperlipidemic medications has occurred? "I will stop taking the medication if it causes nausea and vomiting." "It is important to double my dose if I miss one in order to maintain therapeutic blood levels." "I will continue to modify my diet and keep exercising to help increase my high-density lipoprotein serum levels." "Antihyperlipidemic medications will replace the other interventions I have been doing to try to decrease my cholesterol."

"I will continue to modify my diet and keep exercising to help increase my high-density lipoprotein serum levels." Antihyperlipidemic medications are an addition to, not a replacement for, the therapeutic regimen of diet modification combined with exercise that is used to decrease serum cholesterol levels. The dose should never be doubled if one is missed nor stopped due to side effects. If the medication causes nausea or vomiting, the healthcare provider should be notified. pp. 556, 564

Which statement by an 84-year-old patient with coronary artery disease (CAD) indicates understanding of discharge teaching about physical activity? "I will use longer rest periods between exercise sessions." "I can stop exercising as soon as my cardiac symptoms disappear." "I should exercise outside all the time to achieve better results" "I have to exercise for longer periods of time and more vigorously compared with younger people."

"I will use longer rest periods between exercise sessions." Older adults have to use longer rest periods between exercise sessions because of decreased endurance and ability to tolerate stress. Older adults have decreased sweating and, therefore, shouldn't exercise in hot temperatures. Older adults have to perform low-level activity exercise for longer periods of time. Elderly adults have to change their lifestyles to accommodate a physical activity program, even though they are more prone to make such changes during hospitalization or when experiencing symptoms of CAD. p. 740

Which statement made by the student nurse indicates effective learning about microvascular angina? "It is more common in a patient with diabetic neuropathy." "It occurs at night and is triggered by the patient lying down." "It is common in women and is triggered even by daily activity." "It is commonly seen during rapid eye movement sleep in the patient."

"It is common in women and is triggered even by daily activity." Microvascular angina is a chest pain associated with abnormalities of the coronary microcirculation, occurring especially in women even when performing daily activities. Silent ischemia occurs in the patient with diabetic neuropathy due to the damage of nerves of the cardiovascular system. Nocturnal angina sets in when the patient lies down and is relieved upon standing or sitting. Prinzmetal's angina is very common in patients even during rapid eye movement sleep. p. 752

Which discharge instructions should the nurse include for a patient prescribed cholestyramine? "Mix the drug with water or juice." "Take with all other morning medications." "Take 325 mg of aspirin 30 minutes before each dose." "Notify the healthcare provider if upper abdominal discomfort occurs."

"Mix the drug with water or juice." Cholestyramine is supplied in powdered form. The nurse should instruct the patient to mix the powder with liquids that include water, fruit juices, and soups because swallowing it can cause esophageal irritation. Certain oral medications should be administrated 1 hour before the sequestrant or 4 hours after. Flushing can occur with niacin and can be reduced by taking 325 mg of aspirin 30 minutes before each dose. Gemfibrozil increases the risk of gallstones manifested with symptoms such as upper abdominal discomfort. p. 573

The nurse is teaching a group of patients about dietary approaches to reduce cholesterol levels. Which statement is most important to include in the teaching? "Eliminate red meat and pork from your diet." "Lower your cholesterol intake to 300 mg/day." "Read food labels and reduce your intake of saturated fats." "Reduce salt consumption to keep your sodium intake to 2400 mg/day."

"Read food labels and reduce your intake of saturated fats." An increase in dietary cholesterol intake does not produce a large increase in blood cholesterol because of the body's feedback system. When cholesterol intake increases, endogenous production decreases. However, because the body uses dietary saturated fats to make cholesterol, an increase in saturated fat intake can produce a significant increase in blood cholesterol levels. To lower blood cholesterol, it is most important to lower saturated fat intake. Although red meat and pork should be limited, it is not necessary to eliminate them from the diet. Sodium intake is not directly related to lowering cholesterol levels. p. 557

What advice should the nurse give the patient who has a blood pressure of 150/100 mm Hg? "Reduce total fat intake." "Reduce salt in your diet." "Increase daily physical activity." "Ingest smaller and more frequent meals." "Reduce the amount of complex carbohydrates and fibers in diet."

"Reduce salt in your diet." "Increase daily physical activity." The patient's blood pressure of 150/100 mm Hg is above the normal range and is a major modifiable risk factor. The nurse should advise the patient to consume less salt to lower blood pressure and exercise daily to reduce the risk of coronary artery disease (CAD) from hypertension. If the patient has elevated serum lipids, the nurse should advise the patient to reduce total fat intake. Obese patients should eat smaller and more frequent meals. The nurse should also advise the patient to increase the amount of complex carbohydrates, fiber, and vegetable proteins in the diet for the patient who has elevated serum lipids. p. 736

A patient receiving atorvastatin [Lipitor] therapy to reduce high cholesterol levels calls the clinic and reports, "I am experiencing severe pain in both my legs." What is the nurse's best response? "Stop taking the drug and visit the clinic immediately." "Continue taking the drug; leg pain is a common side effect." "Stop taking the drug if the symptoms persist for another week." "Continue taking the drug along with niacin [Niaspan] and a pain killer."

"Stop taking the drug and visit the clinic immediately." The patient may have pain in both legs due to myopathy, an adverse effect of atorvastatin [Lipitor]. It progresses to a life-threatening condition called rhabdomyolysis, which involves the breakdown of muscle proteins leading to renal failure and death. The nurse should instruct the patient to stop taking the drug and immediately visit the clinic. The nurse will not instruct the patient to continue the drug as it is a life-threatening condition and requires immediate medical attention. The nurse will instruct the patient to watch for the symptoms; rhabdomyolysis further worsens the patient's condition, leading to renal failure. Administration of niacin [Niaspan], along with atorvastatin [Lipitor], further increases the breakdown of muscle proteins and causes rhabdomyolysis. The nurse should ask the patient to stop taking the medication until confirming the cause of the leg pain. p. 569

What should the nurse advise the patient who is on isosorbide mononitrate regarding drug administration? "Take acetaminophen along with the medication." "Discontinue the medication if headache is persistent." "Avoid taking isosorbide mononitrate for eight hours at night." "Have your blood pressure measured after the initial dose." "Take the medication only when symptoms of angina appear."

"Take acetaminophen along with the medication." "Avoid taking isosorbide mononitrate for eight hours at night." "Have your blood pressure measured after the initial dose." The patient should be advised to take acetaminophen along with isosorbide mononitrate to avoid a headache due to the dilation of cerebral blood vessels. The patient should have blood pressure measured after the initial dose because isosorbide mononitrate causes venous dilation that may lead to a drop in blood pressure. The patient should be advised to avoid taking isosorbide mononitrate for a period of eight hours during the night to provide a nitrate-free period in order to prevent the effect of orthostatic hypotension. The patient should not be advised to discontinue the medication even if headaches persist. Isosorbide mononitrate is a long-acting nitrate used to reduce the incidence of anginal attacks and should be taken regularly, not only when angina symptoms are present.

The healthcare provider prescribes procainamide. The patient asks the nurse about how to manage the possible side effects of this medication. What is the nurse's best response? "Take this medication with food to relieve an upset stomach." "Use over-the-counter steroid cream if a red, swollen rash occurs." "Taking an antacid with this medication will relieve digestive problems." "Take diphenhydramine [Benadryl] with the medication if you develop a rash or breathing problems."

"Take this medication with food to relieve an upset stomach." All antidysrhythmics can be taken with food to relieve an upset stomach. Antacids should be taken 2 hours before or 2 hours after taking the antidysrhythmic drugs in order to avoid interfering with drug absorption. The patient should be instructed to notify the prescriber if any type of rash or breathing problems develop. These may be signs of hypersensitivity or a systemic lupus erythematous-like syndrome that can develop in about 30% of patients taking procainamide long-term. p. 545

Which statement of the student nurse indicates effective learning about Prinzmetal's angina? "The patient has to sleep in recumbent position at night." "The patient should moderately exercise the arms to relieve the pain." "The patient should take amphetamines with nitrates during an attack." "The pain in the patient is triggered while performing daily living activities."

"The patient should moderately exercise the arms to relieve the pain." Prinzmetal's angina occurs due to spasms in the coronary artery even when the patient is at rest. The patient may experience cyclic and short bursts of pain that are relieved upon moderate exercise of the arms. Nocturnal angina occurs when the patient is in recumbent position. The patient should not use nitrates and amphetamines together during an attack. Microvascular angina occurs even while performing daily activities due to abnormalities of the coronary microcirculation. p. 742

The nurse teaches a caregiver about ways to reduce the risk of falls in a patient with postprandial hypotension. Which instruction that the caregiver gives to the patient indicates effective learning? "You should drink more water with your meals to stay hydrated." "You should consume less fibrous and fatty food." "You should sit for at least 75 minutes after eating." "You should change your position soon after eating to increase circulation."

"You should sit for at least 75 minutes after eating." The patient with postprandial hypotension shows a drop in blood pressure of 20 mm Hg within 75 minutes after eating. Therefore, the patient should sit for at least 75 minutes after eating to reduce the risk of falls. Drinking excess water with food increases the feeling of satiety and reduces appetite but does not reduce the risk for falls. Changing position soon after eating can result in falls. Eating less fibrous food increases the risk of constipation and does not affect falls. p. 691

CAD complications

(cerebral arteries are on the heart so symptoms & complications directly affect the heart) myocardial infarction

PAD complications

(peripheral arteries affect perfusion to the extremities) arterial ulcers, gangrene (anaerobic- grows without O2), amputation

The nurse recalls that it takes how many seconds for the ventricular conduction system to deliver an impulse? Use a leading zero, if applicable. Record the answer to the second decimal place.

.12 The action potential is generated from the sinoatrial node. It travels through the conduction system including the AV node, bundle of His and the left and right bundle branches. The action potential moves through the walls of both ventricles by means of Purkinje fibers. The ventricular conduction system delivers the impulse within 0.12 second. p. 687

When computing a heart rate from the ECG tracing, the nurse counts 15 of the small blocks between the R waves of a patient whose rhythm is regular. From these data, the nurse calculates the patient's heart rate to be: 60 beats/minute 75 beats/minute 100 beats/minute 150 beats/minute

100 beats/minute Because each small block on the ECG paper represents 0.04 seconds, 1500 of these blocks represent one minute. By dividing the number of small blocks (15 in this case) into 1500, the nurse can calculate the heart rate in a patient whose rhythm is regular (in this case, 100). Sixty beats/minute, 75 beats/minute, and 150 beats/minute are incorrect answers. p. 789

Triglycerides normal value

100-200

The patient's heparin is infusing at 28 mL/hr. The bag of fluid is mixed 20,000 units of heparin in 500 mL D5W. What hourly dose is the patient receiving? Record your answer using a whole number.

1120 units/hr 20,000 units = X units; 500 mL 28 mL/hr; X = 1120 units/hr pp. 601-602

A patient has been classified as having stage 2 hypertension on the basis of the blood pressure recorded. The primary goal of therapy for the patient is to normalize the blood pressure. What should be the target blood pressure for this patient? 120/80 mm Hg 140/90 mm Hg 130/80 mm Hg 150/90 mm Hg

120/80 mm Hg The nurse's goal is to normalize the blood pressure (BP) of this patient. Therefore, the target blood pressure would be 120/80 mm Hg, which is a normal BP. If the patient has a blood pressure within 140 to 159/90 to 99 mm Hg range, then the patient has stage 1 hypertension. This can be controlled by drugs and lifestyle modifications. If the BP of the patient is within 120 to 139/80 to 89 mm Hg, then the patient has prehypertension. Lifestyle modifications are required for this patient to normalize the blood pressure. Blood pressure of 150/90 is indicative of stage 2 hypertension. p. 734

CO normal value

4-8 L

Which drug is a class III antidysrhythmic? Atenolol Lidocaine Verapamil Amiodarone

Amiodarone Class III drugs, such as amiodarone, prolong repolarization in phase 3. Verapamil is a class IV calcium channel blocker that depresses phase 4 depolarization. Lidocaine is a class I membrane-stabilizing antidysrhythmic. Atenolol is a class II beta blocker that depresses phase 4 of depolarization. p. 548

The nurse is ready to begin a heparin infusion for a patient with evolving stroke. The baseline activated partial thromboplastin time (aPTT) is 40 seconds. Which aPTT value indicates that a therapeutic dose has been achieved? 50 70 90 110

70 The therapeutic level of heparin is achieved when the activated partial thromboplastin time (aPTT) reaches 1.5 to 2 times normal. Thus, a range of 60 to 80 seconds would be appropriate for this patient. p. 601

Which patient would the nurse identify being at higher risk for developing coronary artery disease (CAD)? 43-year-old nonsmoking African American male 26-year-old Hispanic male smoking one pack of cigarettes per day 49-year-old Caucasian male with blood pressure 152/92 mm Hg 72-year-old African American female with a cholesterol level of 300 mg/dL

72-year-old African American female with a cholesterol level of 300 mg/dL Multiple risk factors increase the risk of CAD, and this patient has three risk factors: age over 55, African American ethnic background, and cholesterol level greater than 240 mg/dL. The middle-aged nonsmoking AfricanAmerican male has only two risk factors: middle age and male gender: Caucasian middle-age males are more prone to develop CAD. The Hispanic patient has only two risk factors for CAD: male gender and smoking. The middle-aged white male has only two risk factors (age and gender), because systolic blood pressure is less than 160 mm Hg. pp. 732-735

LDL normal value

<160 CAD, DM <70

Cholesterol normal value

<200

Junctional escape rhythm HR & treatment

A patient with junctional escape rhythm shows a heart rate in the range of 40 to 60 beats/minute. Atropine increases the ventricular rate and can effectively improve the junctional escape rhythm p. 797

Which patient assessment would assist the nurse in evaluating therapeutic effects of verapamil [Calan, Covera-HS, Verelan]? Relief of dizziness Prevention of thrombi Absence of chest pain Absence of irregularities in heart rate Decreased swelling in the ankles and feet

Absence of chest pain Absence of irregularities in heart rate Only two calcium channel blockers—verapamil [Calan, Covera-HS, Verelan] and diltiazem [Cardizem, Dilacor-XR, Tiazac, others]—are able to block calcium channels in the heart. Accordingly, they are the only calcium channel blockers used to treat dysrhythmias. Their basic pharmacology is discussed in Chapter 45. Consideration here is limited to their use against dysrhythmias. Calcium channel blockers are also indicated for management of angina. They do not have antithrombotic effects. pp. 551, 581

The cardiac monitor alarm alerts the nurse that a patient is experiencing paroxysmal supraventricular tachycardia (PSVT) with a heart rate of 180 beats/min; the nurse would expect to administer which injectable, fast-acting medication? Lidocaine Adenosine Epinephrine Amiodarone

Adenosine Adenosine [Adenocard] is an unclassified antidysrhythmic drug. It slows the electrical conduction time through the atrioventricular (AV) node and is indicated for the conversion of paroxysmal supraventricular tachycardia (PSVT) to sinus rhythm. Epinephrine, lidocaine, and amiodarone are not the preferred drugs for PSVT. p. 551

The nurse should be least concerned about toxic effects of medication in a patient treated with which medication? Lidocaine Adenosine Amiodarone Procainamide

Adenosine Adenosine has a half-life of an estimated 1.5 to 10 seconds; therefore, toxic effects are least likely with this drug and are self-limiting. Amiodarone may take several days to weeks to be completely excreted. An older adult is at higher risk for toxic effects of medications metabolized by the liver and kidneys. The half-life of lidocaine is only 8 minutes, but the risk of toxic effects on the central nervous system can be significant. p. 551

Which drug administered by the nurse typically produces asystole before converting tachycardia to a sinus rhythm? Atenolol [Tenormin] Diltiazem [Cardizem] Adenosine [Adenocard] Procainamide [Pronestyl]

Adenosine [Adenocard] Adenosine [Adenocard] is an unclassified antidysrhythmic that slows electrical conduction time through the atrioventricular (AV) node. It commonly causes asystole for a period of seconds before ideally converting to normal sinus rhythm. Repeat doses may be necessary to achieve desired results. Diltiazem [Cardizem] is a class IV antidysrhythmic, or calcium channel blocker. Atenolol [Tenormin] is a class II antidysrhythmic, or beta blocker. Procainamide [Pronestyl] is a class IA antidysrhythmic drug. p. 538, Table 49-1

When observing a new staff nurse preparing to administer diltiazem [Cardizem], the charge nurse should approve which action? Administering the drug via an infusion pump. Drawing up the medication in a heparin flush. Pushing the medication intravenously over 30 seconds. Hanging the medication secondary to a free hanging dextrose solution.

Administering the drug via an infusion pump. It is recommended that an infusion pump be used for intravenous dosing of any of the classes of antidysrhythmics, with proper solution and dilution. A diltiazem [Cardizem] drip should be hung as a primary intravenous (IV) drip. IV incompatibilities should be checked before administration. Dextrose is incompatible with many medications. Diltiazem [Cardizem] should not be injected quickly. p. 551

The nurse reviews the plan of care for a patient with chest pain, an oxygen saturation of 90 percent, a pulse rate of 110 beats per minute, and slight dyspnea. Which item listed on the plan should the nurse question? Advise the patient to remain on complete bed rest. Instruct the patient on how to perform relaxed breathing and imagery. Encourage the patient to exercise regularly. Encourage the patient to verbalize feelings and perceptions.

Advise the patient to remain on complete bed rest. Complete bed rest should be limited to reduce complications. Performing 30 minutes of exercise per day will help avoid fatigue and increase activity tolerance without rapidly increasing cardiac workload. The nurse should instruct the patient with anxiety and stress to use relaxation breathing and imagery and encourage verbalization of feelings and perceptions. This helps in providing comfort and support to the patient. p. 754

Which are positive risk factors for atherosclerotic cardiovascular disease (ASCVD)? African American race Blood pressure of 130/85 mm Hg Blood pressure higher than 140/90 mm Hg High-density lipoprotein is 60 mg/dL or higher Serum triglyceride level of 150 mg/dL or more

African American race Blood pressure higher than 140/90 mm Hg The positive risk factors for atherosclerotic cardiovascular disease (ASCVD) include being of African American race. Hypertension is characterized by an increase in blood pressure, which may be 140/90 mm Hg, indicating that the individual has a coronary heart disease (CHD) risk. If the high-density lipoprotein (HDL) cholesterol is 60 mg/dL or higher, it is a negative risk factor for CHD. A serum triglyceride level of 150 mg/dL or more and blood pressure of 130/85 mm Hg or higher are identifying features of metabolic syndrome but not risk factors for CHD. p. 561

The nurse assesses a patient with diaphoresis, weakness, periumbilical pain, pallor, and a pulsating abdominal mass. The patient's heart rate is 120 beats/minute and blood pressure is 90/60 mm Hg. What does the nurse suspect is occurring with this patient? Aneurysm rupture Marfan's syndrome Metoprolol adverse effects Superficial vein thrombosis

Aneurysm rupture Dilation of the aorta indicates aortic aneurysms. Diaphoresis, weakness, periumbilical pain, tachycardia, pallor, pulsating abdominal mass, and hypotension are the symptoms of aneurysm rupture. Marfan's syndrome is a genetic disorder and it affects the body's connective tissue. Dizziness, depression, fatigue, and erectile dysfunction are adverse effects of metoprolol. Tenderness, itching, redness, warmth, pain, and inflammation of the leg vein are the symptoms of superficial vein thrombosis. p. 844

Which test is used to map the entire aortic system? X-ray study Angiography Ultrasound study Electrocardiogram

Angiography Contrast media, which gives contrast images to map the entire aortic system, is used in angiography. An x-ray study shows calcification within the aortic wall. An ultrasound study is used to monitor the aneurysm size. An electrocardiogram is used to assess the function of the aortic valve. p. 842

The nurse recognizes that which type of medication may be prescribed for a patient with an ejection fraction of 25%? Lipid lowering agent Beta-adrenergic blocker Calcium channel blocker Angiotensin-converting enzyme (ACE) inhibitor

Angiotensin-converting enzyme (ACE) inhibitor Angiotensin converting enzyme inhibitors improve ejection fraction, prevents ventricular remodeling, and prevents the progression of heart failure in the patient. Lipid lowering agents reduce low density cholesterol and triglyceride levels in the blood. Beta-adrenergic blockers decrease myocardial oxygen demand by reducing heart rate, blood pressure, and contractility. Calcium channel blockers are prescribed to decrease blood pressure in patients with beta blocker intolerance and Prinzmetal's angina. p. 753

A patient visiting the clinic has been taking amiodarone for several months. The nurse observes a bluish discoloration in the patient's skin. Which action should the nurse perform first? Apply an oxygen mask. Call the healthcare provider. Call for crash cart to resuscitate the patient. Apply a pulse oximeter to check oxygen levels.

Apply a pulse oximeter to check oxygen levels. Assess first. Amiodarone can be absorbed in fat and manifest as a bluish discoloration. Before assuming the patient is cyanotic, the nurse should fully assess the patient. If the patient's assessment findings are consistent with hypoxia (eg, low oxygen levels obtained via pulse oximetry), the next steps include oxygen application, notifying the healthcare provider, and possible crash cart retrieval. In the case of amiodarone skin discoloration, the nurse will identify that the problem is not related to oxygen deficit. pp. 548-549

A patient admitted with deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) requires immediate anticoagulation. Which medication would be appropriate for initial therapy for this patient who has a history of heparin-induced thrombocytopenia (HIT)? Warfarin [Coumadin] Argatroban [Acovan] Eptifibatide [Integrilin] Bivalirudin [Angiomax]

Argatroban [Acovan] Argatroban [Acovan] is indicated for the treatment of thrombosis in patients with a history of heparin-induced thrombocytopenia (HIT). Because this medications are given as an initial IV bolus followed by a continuous infusion, the desired effect of direct thrombin inhibition is achieved more quickly. Because of warfarin's delayed onset of effects, it is not useful in emergency situations, such as pulmonary embolism (PE). Intravenous bivalirudin [Angiomax] given in combination with aspirin helps prevent clot formation in patients undergoing coronary angioplasty. Eptifibatide [Integrilin], a glycoprotein IIb/IIIa receptor inhibitor, is an antiplatelet drug that is used short term to prevent ischemic events in patients who have acute coronary syndrome or who are undergoing percutaneous coronary intervention. pp. 601, 610

A patient who is on a cardiac monitor is shivering. What should the nurse expect to see on this patient's tracing? Artifact Asystole Atrial flutter Junctional dysrhythmia

Artifact An artifact is a distortion of the baseline and waveforms seen on the electrocardiogram (ECG). If the patient is shivering or shows any muscle activity, accurate interpretation of the heart rhythm is difficult and artifacts can occur on the monitor. Asystole is the absence of all cardiac electrical activity. Atrial flutter occurs in chronic lung disease or hypertension. Junctional dysrhythmias are associated with an electrolyte imbalance or rheumatic heart disease. p. 790

The nurse would assess a patient with complaints of chest pain for which clinical manifestations associated with a myocardial infarction (MI)? Flushing Ashen skin Diaphoresis Nausea and vomiting S3 or S4 heart sounds

Ashen skin Diaphoresis Nausea and vomiting S3 or S4 heart sounds During the initial phase of an MI, catecholamines are released from the ischemic myocardial cells, causing increased sympathetic nervous system (SNS) stimulation. This results in the release of glycogen, diaphoresis, and vasoconstriction of peripheral blood vessels. The patient's skin may be ashen, cool, and clammy (not flushed) as a result of this response. Nausea and vomiting may result from reflex stimulation of the vomiting center by severe pain. Ventricular dysfunction resulting from the MI may lead to the presence of the abnormal S3 and S4 heart sounds. p. 754

Which drugs are used in the dual antiplatelet therapy after a stent placement? Aspirin Losartan Captopril Ticagrelor Ranolazine

Aspirin Ticagrelor Aspirin is an antiplatelet drug that helps prevent thrombosis around the stent. Ticagrelor is also an antiplatelet drug and helps prevent clotting around the stent, thus maintaining its patency. Captopril is an angiotensin-converting enzyme inhibitor used to treat high risk chronic stable angina. Losartan is an angiotensin II receptor blocker used in patients who are intolerant of angiotensin-converting enzyme (ACE) inhibitors. Ranolazine is a sodium current inhibitor, used to treat chronic angina refractory to other medications. p. 744

A patient with atherosclerosis has an ankle brachial index (ABI) of 0.8, decreased Doppler pressures, aspirin intolerance, and the duplex imaging of the patient shows arterial stenosis. What is the best treatment choice? Nifedipine Clopidogrel Furosemide Doxycycline

Clopidogrel The patient's symptoms suggest peripheral artery disease (PAD), which is treated with antiplatelet drugs. Because the patient has aspirin intolerance, clopidogrel would be beneficial. Nifedipine is a calcium channel blocker used to reduce the severity of a vasospastic attack. Furosemide is a diuretic and used to treat hypertension. Doxycycline is used to treat aortic aneurysms. p. 836

A patient with warfarin [Coumadin] toxicity is prescribed vitamin K (phytonadione). Which nursing assessment ensures patient safety? Assess the prothrombin time. Assess the amount of blood lost. Assess the white blood cell count. Assess the partial thromboplastin time.

Assess the prothrombin time. Warfarin [Coumadin] can cause blood loss in the patient; thus, it is important to assess the duration of clotting. The duration of clotting can be assessed by finding the prothrombin time. Use of partial thromboplastin time would be used to assess heparin therapy. Knowing the amount of blood lost is not required for the administration of vitamin K (phytonadione). The amount of blood lost would help determine if the patient needs a blood infusion. The white blood cell count is helpful in determining the presence of infection. This assessment is not required for a patient who is administered vitamin K (phytonadione). p. 604-605

The nurse teaches a patient that supraventricular dysrhythmia is less serious than a ventricular dysrhythmia. What is the rationale for this statement? Atrial dysrhythmias are easily treated. Atrial conduction is not influenced by medication. Atrial heart rate does not influence ventricular rate. Atrial action does not significantly reduce cardiac output.

Atrial action does not significantly reduce cardiac output. Supraventricular dysrhythmias are dysrhythmias that arise in the areas of the heart above the ventricles. Supraventricular dysrhythmias are not as harmful because dysrhythmic activity within the atria does not significantly reduce cardiac output except in patients with valvular disorders and heart failure. p. 541

A nurse finds that a patient has an atrial rate of 450 beats per minute and a ventricular rate of 150 beats per minute. What condition is the patient likely experiencing? Atrial flutter Atrial fibrillation Ventricular fibrillation Premature ventricular contractions

Atrial fibrillation Atrial fibrillation is characterized by alterations in electrical conductivity of the atrium. The atrial rate is as high as 350 beats per minute to 600 beats per minute. Atrial fibrillation with controlled ventricular response is observed at a ventricular rate of 60 beats per minute to 100 beats per minute. A ventricular rate above 100 beats per minute is considered as atrial fibrillation with uncontrolled ventricular response. The atrial rate and ventricular rate in atrial flutter occur at the ratio of 2:1. The atrial rate is observed between 200 beats per minute to 350 beats per minute and the ventricular rate occurs at 150 beats per minute. Ventricular fibrillation elicits dysrhythmia and P wave and QRS complex cannot be predicted. Premature ventricular contractions elicit dysrhythmia with deflections in the heart rate. pp. 796-797

A nurse is caring for a patient experiencing sinus bradycardia. Which drugs are used to treat bradycardia? Atropine Dopamine Adenosine Metoprolol Epinephrine

Atropine Dopamine Epinephrine Sinus bradycardia is a condition in which the sinoatrial node elicits a heartbeat at a rate of less than 80 beats per minute. Sinus bradycardia is associated with hypotension, weakness, dizziness, and shortness of breath. It can be treated by the administration of atropine, an anticholinergic drug. Sympathomimetic drugs like dopamine and epinephrine are administered if atropine is ineffective. Beta blockers like adenosine and metoprolol are used in the treatment of sinus tachycardia. pp. 793-794

Which patient teaching points should the nurse include when providing discharge instructions to a patient with an implantable cardioverter-defibrillator (ICD)? Avoid or limit air travel. Avoid large magnets and strong electromagnetic fields. Obtain and wear a Medic Alert ID or bracelet at all times. Avoid lifting arm on ICD side above shoulder until approved. Do not walk through antitheft devices in doorways of stores and public buildings.

Avoid large magnets and strong electromagnetic fields. Obtain and wear a Medic Alert ID or bracelet at all times. Avoid lifting arm on ICD side above shoulder until approved. Patients with ICDs need to avoid large magnets and strong electromagnetic fields, because they may interfere with ICD function. These patients need to obtain and wear a MedicAlert ID or bracelet at all times, and avoid lifting their arms on the ICD side above their shoulders until approved. These patients do not need to avoid air travel; they can walk through antitheft devices at a normal pace but should not stand next to them. p. 803

Which signs and symptoms does the nurse observe in a patient whose laboratory report shows calcification within the aortic wall and abnormal widening of the thoracic wall? Back pain Epigastric discomfort Bluish fingers and toes Decreased urine output Altered bowel elimination

Back pain Epigastric discomfort Altered bowel elimination Back pain, epigastric discomfort, and altered bowel elimination are associated with aortic aneurysms. Bluish fingers and toes, pallor, pain, and numbness are symptoms of Raynaud's phenomenon. Decreased urine output is associated with aneurysm rupture. p. 842

The nurse is assessing a patient who has hyperlipidemia and who is treated with antihyperlipidemic medications. The nurse realizes bile acid sequestrants may cause what interaction? Decreased urination Binding with digoxin Binding with warfarin Inactivation with food Elevated blood pressure

Binding with digoxin Binding with warfarin The bile-acid sequestrants can form insoluble complexes with other drugs. Medications that undergo binding cannot be absorbed and hence are not available for systemic effects. Drugs known to form complexes with the sequestrants include thiazide diuretics, digoxin, warfarin, and some antibiotics. To reduce formation of sequestrant-drug complexes, oral medications that are known to interact should be administered either 1 hour before the sequestrant or 4 hours after. pp. 572-573

The nurse is reviewing the mechanism of blood pressure (BP). What are the main factors that influence blood pressure? Cardiac output Capillary refill Oxygen saturation Pulmonary pressure Systemic vascular resistance

Cardiac Output Systemic Vascular Resistance The two main factors influencing BP are cardiac output and systemic vascular resistance. Capillary refill, oxygen saturation, and pulmonary pressure do not influence blood pressure. p. 690

The nurse is caring for a patient who has undergone kidney transplantation. The patient's laboratory reports show hyperlipidemia. Which antihyperlipidemic drug would be most beneficial for the patient? Fluvastatin [Lescol] Cyclosporin [Gengraf] Colesevelam [Welchol] Cholestyramine [Questran]

Colesevelam [Welchol] Colesevelam [Welchol] is better tolerated by high-risk patients who have intolerance to other antilipidemic medications. It can be prescribed for patients who have undergone organ transplantation or have serious liver or kidney disease. Fluvastatin [Lescol] is not used in patients with organ transplantation as it may increase the risk of rhabdomyolysis. Cyclosporin [Gengraf] is an immunosuppressant drug, not an antihyperlipidemic drug. Cholestyramine [Questran] is used for constipation and has more side effects than colesevelam [Welchol]; it is therefore not as beneficial as colesevelam [Welchol]. pp. 572-573

The nurse is caring for a patient who has been experiencing ventricular dysrhythmias without atrial involvement. The nurse would anticipate that the patient will be placed on which class drug? Class II Class IA Class IB Class IC

Class IB The class IB drug lidocaine is given for ventricular dysrhythmias only. p. 542

The nurse is caring for a patient who takes multiple cholesterol-lowering drugs. Which drug is least likely to cause systemic side effects? Gemfibrozil [Lopid] Simvastatin [Zocor] Colesevelam [Welchol] Nicotinic acid [Niaspan]

Colesevelam [Welchol] Colesevelam [Welchol], a bile acid sequestrant, is a nonabsorbable resin that works directly in the gastrointestinal tract. Because it and other bile acid sequestrants (eg, cholestyramine [Questran] and colestipol [Colestid]) are not absorbed, they do not have systemic effects. The most common complication of bile acid sequestrants is constipation. The other agents have potential systemic adverse effects. p. 572

A female patient complains of chest pain while at work. Which contributed to the patient's condition? Angina decubitus Diabetic neuropathy Raynaud's phenomenon Coronary microvascular disease

Coronary microvascular disease Microvascular angina occurs due to myocardial ischemia, which is associated with abnormalities of the coronary circulation and can also be triggered by daily activities. The patient with angina decubitus experiences chest pain while lying down and is usually relieved by standing or sitting. Diabetic neuropathy leads to damage of the nerves of the coronary system leading to silent ischemia. The patient with a history of Raynaud's phenomenon may experience Prinzmetal's angina. p. 742

Myocardial ischemia ECG

Decreased blood and oxygen to the heart muscle (myocardial ischemia) results in ST segment depression.

Which action does flecainide have on the heart? Decreases conduction Decreases automaticity Accelerates repolarization Reduces myocardial contractility

Decreases conduction Flecainide is a class IC sodium channel blocker; it decreases impulse conduction in patients. Mexiletine is a class IB sodium channel blocker that accelerates repolarization. β-adrenergic blockers like esmolol decrease the automaticity of the sinoatrial node. Myocardial contractility is reduced with diltiazem, a calcium channel blocker. p. 801

How does esmolol affect an ECG? Delaying repolarization Accelerating repolarization Decreasing automaticity of the SA node Slowing the impulse conduction in the AV node Suppressing atrial dysrhythmias through an unknown mechanism

Decreasing automaticity of the SA node Slowing the impulse conduction in the AV node Esmolol is a β-adrenergic blocker that decreases the automaticity of the SA node and slows the impulse conduction in the AV node. Esmolol causes prolonged PR intervals. Potassium channel blockers delay repolarization. Class IB sodium channel blockers accelerate repolarization. Esmolol does not suppress atrial dysrhythmias through an unknown mechanism. p. 801

What does the QRS complex represent in an electrocardiogram? Depolarization of the atria Repolarization of the ventricle Depolarization of both the ventricles Repolarization of the Purkinje fibers

Depolarization of both the ventricles An electrocardiogram is commonly used to detect abnormal heart rhythms and to investigate the cause of chest pains. Time taken for depolarization of both the ventricles is represented by the QRS interval. Depolarization of the atria is represented by the P wave. The T wave in the electrocardiogram should be upright, and it represents time for ventricular repolarization. If present, the U wave indicates the repolarization of the Purkinje fibers. p. 688

Which is the most important assessment to complete before the nurse administers an antidysrhythmic medication? Pulse Temperature Respiratory rate Auscultation of lungs

Pulse When antidysrhythmic drugs are administered, the nurse should monitor vital signs, especially pulse rate and blood pressure. If the pulse is lower than 60 beats/min, the nurse should notify the prescriber. p. 538

The nurse should monitor for which adverse effects in a patient who takes amiodarone? Dyspnea Hypertension Hyperthyroidism Light sensitivity Elevated liver enzymes

Dyspnea Hyperthyroidism Light sensitivity Elevated Liver Enzymes Amiodarone, a class III drug, may lead to pulmonary toxicity (evidenced by dyspnea and alveolar damage), thyroid disorders (hypo- or hyperthyroidism), decrease in blood pressure and pulse rate, photosensitivity, and abnormal liver function. p. 548

A hospitalized patient is two days post myocardial infarction. What possible complications should the nurse monitor the patient for at this stage in recovery? . Dysrhythmia Heart failure Pericarditis Dressler's syndrome Cardiogenic shock

Dysrhythmia Heart failure Pericarditis Cardiogenic shock Dysrhythmia, heart failure, pericarditis, and cardiogenic shock are all serious complications that can arise immediately and several days after myocardial infarction. Dressler's syndrome is also a possible complication post myocardial infarction but presents as pericarditis with effusion and fever that develops four to six weeks later. p. 748

A nurse works in a critical care unit. When attending to a patient, the nurse finds that the patient has developed atrial fibrillation. What should be the treatment for this patient? Electrical cardioversion Oxygen therapy Anticoagulation therapy Atropine injection Prepare for radiofrequency catheter ablation

Electrical cardioversion Anticoagulation therapy Prepare for radiofrequency catheter ablation Electrical cardioversion converts the atrial fibrillation into normal sinus rhythm. If a patient is in atrial fibrillation for more than 48 hours, anticoagulation therapy with warfarin will be required for three to four weeks. This should commence before the cardioversion and has to be continued for several weeks after successful cardioversion. For patients with drug-refractory atrial fibrillation or those who do not respond to electrical conversion, radiofrequency catheter ablation may be done. Administering oxygen may not be required. Atropine injection is not required in atrial fibrillation. However, it may be required in cases of certain atrioventricular blocks. p. 796

A patient with a heart rate of 120 beats/minute is prescribed antidysrhythmic drugs. What additional diagnostic test does the nurse expect to be prescribed for this patient? Holter monitoring Electrophysiologic study Exercise treadmill testing Signal-averaged electrocardiogram

Electrophysiologic study An electrophysiologic study identifies the causes of heart blocks, tachydysrhythmias, bradydysrhythmias, and syncope. It can also locate accessory pathways and determine the effectiveness of antidysrhythmic drugs. A Holter monitor is used to record electrocardiogram when the patient is ambulatory and performing daily activities. Exercise treadmill testing evaluates the patient's heart rhythm during exercise. Signal-averaged electrocardiogram identifies the late potential if the patient is at risk of developing serious arrhythmias. p. 792

Which assessment finding in a patient taking an HMG-CoA reductase inhibitor will the nurse act on immediately? Decreased hemoglobin Elevated liver function tests Elevated low-density lipoprotein (LDL) cholesterol Elevated high-density lipoprotein (HDL) cholesterol

Elevated liver function tests HMG-CoA reductase inhibitors (statins) can cause hepatic toxicity; thus, it is necessary to monitor liver function tests. The nurse should act on this finding immediately. Decreased hemoglobin should be addressed, but not immediately. It is most likely not related to the administration of the HMG-CoA reductase inhibitor. Also, while an elevated LDL level must be addressed, it is not as high a priority as the elevated liver function test results. An elevated HDL is a positive finding and an encouraging result. p. 570

A patient who was admitted with deep vein thrombophlebitis is complaining of difficulty breathing and chest pain. What is the most likely cause of these symptoms? Anxiety Medication reaction Embolus to the lungs Fatigue from the extra work of walking with pain

Embolus to the lungs A thrombus can become an embolus and travel to the lungs. This pulmonary embolus can cause chest pain and difficulty breathing. It is not likely that fatigue, anxiety, or a medication reaction would cause chest pain and dyspnea in this case. pp. 597-598, 619

Which drug causes vasodilation by preventing conversion of angiotensin I to angiotensin II? Enalapril Losartan Amlodipine Nitroglycerine

Enalapril Enalapril is an angiotensin-converting enzyme (ACE) inhibitor that inhibits the conversion of angiotensin I to angiotensin II, resulting in vasodilation. Losartan is an angiotensin II receptor blocker that inhibits the binding of angiotensin II to angiotensin I receptors. Amlodipine is a calcium channel blocker that prevents calcium entry into the vascular smooth muscles and myocytes. Nitroglycerine is short-acting nitrate that causes peripheral vasodilation, thereby decreasing preload and afterload. p. 744

The nurse provides teaching to a patient who will take atorvastatin [Lipitor] at home. Which patient teaching is most likely to help maintain the anti-lipemic medication dosage at the lowest level possible? Avoid all alcoholic beverages. Engage in moderate exercise. Adhere to the blood test schedule. Take atorvastatin [Lipitor] at bedtime.

Engage in moderate exercise. The nurse instructs the patient to engage in moderate-intensity exercise to improve cardiovascular conditioning. Exercise helps increase metabolism and promotes collateral circulation. Taking atorvastatin [Lipitor] at bedtime, adhering to the blood test schedule, and avoiding alcoholic beverages all help manage adverse effects and aid in the early detection of serious adverse effects; however, these reasonable nursing interventions for patient teaching are less likely to affect the dosage of atorvastatin [Lipitor]. p. 577

Which anti-lipemic medication reduces serum cholesterol by inhibiting its absorption in the small intestine? Niacin [Niaspan] Ezetimibe [Zetia] Rosuvastatin [Crestor] Cholestyramine [Questran]

Ezetimibe [Zetia] Ezetimibe [Zetia], the only cholesterol absorption inhibitor on the U.S. market, is effective in lowering total cholesterol, low-density lipoprotein (LDL) cholesterol, apolipoprotein B, and triglyceride levels. Niacin [Niaspan] is a vitamin administered in large doses to lower serum cholesterol levels. Rosuvastatin is a hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor that lowers serum cholesterol levels. Cholestyramine [Questran] is a bile acid sequestrant. p. 573

A patient diagnosed with hypercholesterolemia is prescribed lovastatin [Mevacor]. Based on this medication order, the nurse will contact the healthcare provider about which reported condition in the patient's history? Leukemia Renal disease Hepatic disease Chronic pulmonary disease

Hepatic disease Lovastatin [Mevacor] can cause an increase in liver enzymes and thus should not be used in patients with preexisting liver disease. Leukemia, renal disease, and chronic pulmonary disease are not contraindications to using lovastatin. p. 570

First Degree AV block EGC results & interventions

First degree AV block is a benign rhythm so no interventions are necessary

A nurse is assessing an older adult patient who is diagnosed with coronary artery disease. An angiogram reveals that the patient has 80 percent blockage of the left circumflex artery and 70 percent blockage of the right coronary artery. The patient does not show any symptoms of coronary ischemia. What is the most appropriate reason for this finding? Lowering of low-density lipoprotein (LDL) levels in the body Pulmonary artery supplies oxygenated blood to the heart Formation of collaterals in the coronary circulation Increased production of C-reactive proteins in the liver

Formation of collaterals in the coronary circulation This patient is an older adult and, therefore, the occlusion may have occurred slowly over a long period of time. Collateral circulation may have developed which provides adequate blood supply to the myocardium, thereby preventing ischemia. Lowering LDL does not prevent coronary ischemia in the patient whose myocardial blood supply is already compromised. The pulmonary artery consists of deoxygenated blood and does not supply blood to the coronary arteries unless there is a congenital anatomic variation. C-reactive proteins are inflammatory markers that are increased in patients with coronary artery disease. These are not associated with reducing coronary ischemia. pp. 731, 732, 734

CO equation

HR x stroke volume

A patient is admitted for placement of a permanent pacemaker. Which health problem does the nurse suspect in this patient? Heart failure Tachydysrhythmias Acute inferior myocardial infarction Complication from open-heart surgery

Heart failure A permanent pacemaker is indicated in a patient with heart failure. A temporary pacemaker is indicated in patients recovering from tachydysrhythmias, inferior myocardial infarction, and open-heart surgery. p. 804

The nurse is caring for a patient who has coronary heart disease (CHD). The nurse tells the patient, "Your cholesterol levels are abnormal; you are at a high risk of having a heart attack." What did the nurse discover regarding the lipoprotein levels in the patient's blood report? High levels of low-density lipoproteins (LDL) High levels of high-density lipoproteins (HDL) Low levels of very-low-density lipoproteins (VLDL) Low levels of intermediate-density lipoproteins (IDL)

High levels of low-density lipoproteins (LDL) High level of low-density lipoproteins (LDL) refers to high cholesterol levels in the blood, as LDL is almost entirely composed of cholesterol. This cholesterol is bad cholesterol, which promotes the formation of atherosclerotic plaque resulting in CHD. High-density lipoproteins (HDL) are good cholesterol, which has a cardioprotective action. Low levels of very-low-density lipoproteins (VLDL) are due to a low fat diet; however, it does not cause high cholesterol levels. Low levels of intermediate-density lipoproteins (IDL) do not increase the risk of CHD; they are useful for the production of bile acids. pp. 560-561

The lipid profile of a patient is indicative of hyperlipidemia. A nurse advises the patient to consume a diet rich in nutrients that would increase high-density lipoprotein levels based on what rationale? High-density lipoproteins (HDLs) transport lipids to the liver. High-density lipoproteins (HDLs) prevent stiffening of arterial walls. High-density lipoproteins (HDLs) prevent deposition of lipids in the blood vessels. High-density lipoproteins (HDLs) inhibit the production of low-density lipoproteins (LDLs). High-density lipoproteins (HDLs) stimulate the liver to break down more low-density lipoproteins.

High-density lipoproteins (HDLs) transport lipids to the liver. High-density lipoproteins (HDLs) prevent deposition of lipids in the blood vessels. High-density lipoproteins and low-density lipoproteins are vehicles for mobilization of fats. HDLs contain fewer lipids than proteins and mobilize lipids from the arteries to the liver for metabolism, thereby preventing the deposition of lipids on the vessel wall. LDLs have more lipid content than proteins and tend to deposit lipids in the arterial walls. HDLs prevent the deposition of lipids and do not directly alter the vessel wall or make it noncompliant. HDLs do not interfere with the production or breakdown of LDLs. pp. 733-734

Which assessment finding in a patient with cardiac risk factors should be reported immediately if the patient is taking a nonselective beta blocker? Chest pain Weight loss History of asthma History of alcohol abuse

History of asthma Beta blockers must be used cautiously in patients with a history of asthma because the drugs induce bronchoconstriction and increased airway resistance, which may further cause dyspnea and wheezing. Weight loss is not a concern for patients with cardiac risk factors who are taking nonselective beta blockers; however, weight gain may indicate edema. Beta blockers are effective in the treatment of angina or chest pain. Although beta blockers can interact with alcohol and cause adverse effects, such as hypotension, a history of alcohol abuse is not a concern if the patient no longer engages in such behavior. p. 546

While performing the head-up tilt-test the blood pressure and heart rate in an unconscious patient are unresponsive after 30 minutes. Which treatment does the nurse expect to be prescribed for this patient? IV adenosine IV midazolam IV magnesium IV infusion of low-dose isoproterenol

IV infusion of low-dose isoproterenol A head-up tilt-test is a procedure used to determine the cause of fainting spells in a patient. In the head-up tilt-test, the patient is placed on a table supported by a belt across the torso and feet. The electrocardiogram and heart rate are recorded continuously and blood pressure is measured every three minutes throughout the test. If the patient's BP and HR responses are abnormal and faintness is reproduced, the test is considered positive. If after 30 minutes there is no response, the table is returned to the horizontal position and an IV infusion of low-dose isoproterenol is started to provoke a response. IV adenosine is the drug used in the treatment of paroxysmal supraventricular tachycardia. IV midazolam is used to sedate a patient before performing synchronized cardioversion. IV magnesium is used to treat polymorphic ventricular tachycardia with a prolonged baseline QT interval. p. 808

A patient experienced sudden cardiac death (SCD) while hospitalized and survived. What should the nurse expect to be used as a preventive treatment for this patient while at home? External pacemaker An electrophysiologic study (EPS) Medications to prevent dysrhythmias Implantable cardioverter-defibrillator (ICD)

Implantable cardioverter-defibrillator (ICD) An ICD is the most common approach to preventing recurrence of SCD. An external pacemaker may be used in the hospital, but will not be used for the patient living daily life at home. An EPS may be done to determine if a recurrence is likely and determine the most effective medication treatment. Medications to prevent dysrhythmias are used, but are not best for prevention of SCD. p. 762

A teenage girl survived an episode of sudden cardiac death (SCD) and is recovering in the intensive care unit (ICU). The nurse anticipates which intervention to prevent a recurrence? Drug therapy with beta-blocker Coronary artery bypass graft (CABG) Percutaneous coronary intervention (PCI) Implantable cardioverter-defibrillator (ICD)

Implantable cardioverter-defibrillator (ICD) The most common approach to preventing a recurrence is the use of an ICD. It has been shown that an ICD improves survival compared with drug therapy alone. Drug therapy and a PCI will not prevent a recurrence of SCD. A coronary artery bypass graft is not necessary. p. 763

What are the common side effects of fenofibrate [Tricor], a fibric acid derivative? Impotence Constipation Cutaneous flushing Nausea and abdominal pain Increase in gallstone formation

Impotence Nausea & Abd. Pain Increase in gallstone formation Impotence, nausea, abdominal pain and an increase in gallstone formation are the adverse effects produced by fenofibrate [Tricor]. Diarrhea, not constipation, is a common side effect of fibric acid derivatives. Cutaneous flushing is an adverse effect produced by niacin. Constipation and cutaneous flushing are not associated with fenofibrate [Tricor]. p. 574

A patient with chest pain has a heart rate of 200 beats/minute and blood pressure of 80/50 mm Hg. The electrocardiogram shows absent P waves. Which medication should the nurse expect to be prescribed for this patient? Intravenous Digoxin Intravenous Atropine Intravenous Vasopressin Intravenous adenosine

Intravenous adenosine Paroxysmal supraventricular tachycardia (PSVT) is a dysrhythmia starting in an ectopic focus anywhere above the bifurcation of the bundle of His. The symptoms associated with PSVT include hypotension, palpitations, dyspnea, and angina. In PSVT, the heart rate will be greater than 180 beats/minute and the electrocardiogram will often show a hidden P wave. Intravenous adenosine is the standard drug for paroxysmal supraventricular tachycardia. Digoxin, atropine, and vasopressin are not prescribed for paroxysmal supraventricular tachycardia. Digoxin is used in the treatment of atrial fibrillation. Atropine is used in the treatment of junctional escape rhythm. Vasopressin is used in the treatment of asystole. p. 795

The nurse is providing care for a patient who has decreased cardiac output related to heart failure. What should the nurse understand about cardiac output? It is calculated by multiplying the patient's stroke volume by the heart rate. It is the average amount of blood ejected during one complete cardiac cycle. It is determined by measuring the electrical activity of the heart and the patient's heart rate. It is the patient's average resting heart rate multiplied by the patient's mean arterial blood pressure.

It is calculated by multiplying the patient's stroke volume by the heart rate. Cardiac output is determined by multiplying the patient's stroke volume by heart rate, thus identifying how much blood is pumped by the heart over a one-minute period. Electrical activity of the heart and blood pressure are not direct components of cardiac output. p. 689

A patient has a severe blockage in the left coronary artery. The nurse knows that the cardiac structures that are most likely to be affected by this blockage include which of these? Left atrium Bundle of His Left ventricle Interventricular septum Atrioventricular (AV) node

Left atrium Left ventricle Interventricular septum The left coronary artery arises from the aorta and divides into two main branches: the left anterior descending artery and the left circumflex artery. These arteries supply the left atrium, the left ventricle, the interventricular septum, and a portion of the right ventricle. The AV node and bundle of His are supplied by the right coronary artery. p. 688

The nurse is interpreting an electrocardiogram (ECG). Which component represents the depolarization of the ventricles? T wave P wave ST segment QRS complex

QRS complex An electrocardiogram has several components. The QRS complex is caused by depolarization of the ventricles; the P wave is caused by depolarization in the atria; and the T wave is caused by repolarization of the ventricles. The ST segment may be depressed in some clinical conditions. p. 537

The primary health care provider suggests the patient with stable angina who is receiving treatment avoid isosorbide dinitrate at night unless symptoms occur. The risk of which complication is reduced through this intervention? Depression Atherosclerosis Medication Tolerance Orthostatic hypotension Raynaud's phenomenon

Medication Tolerance Orthostatic hypotension The patient receiving nitrates must be on a nitrate-free period every day usually for eight hours in the night to limit the effect of orthostatic hypotension, which is caused by venous dilation. Patient tolerance to medication-induced vasodilation can be avoided through eight-hour breaks in dosage. Depression may occur due to beta-blockers. Atherosclerosis is the primary reason for myocardial ischemia in the patient with stable and unstable angina. Raynaud's phenomenon can cause Prinzmetal's angina. p. 745

A patient with sudden stabbing pain in the chest, arms, and shoulders at unusual times of the day and night is on short-acting nitrates. Which intervention helps promote better care management in the patient? Monitor for QT interval prolongation. Monitor for decrease in the heart rate. Monitor for decrease in blood pressure. Monitor for decreased ejection fraction.

Monitor for decrease in blood pressure. The patient has symptoms of unstable angina. The patient on short-acting nitrates such as nitroglycerin may experience orthostatic hypotension, so the blood pressure of the patient should be monitored regularly and the patient asked to make slow movements. A patient on fluoxetine must undergo monitoring for QT interval prolongation because this medication prolongs the QT interval. The patient on beta-adrenergic blockers may experience bradycardia and should be monitored for a decrease in the heart rate. The patients with heart failure should be monitored for ejection fraction. p. 743

A patient has undergone peripheral artery bypass surgery. The patient is diabetic, has a history of chronic ischemic rest pain, and has been taking opioids for more than a year. Which postoperative nursing interventions are appropriate for the patient? Monitor perfusion to the extremities Suggest the patient stop taking opioids Encourage the patient to practice meticulous foot care Teach the patient or caregiver about wound management Encourage the patient to drink juices with refined sugar Report any potential complications, such as bleeding or thrombosis

Monitor perfusion to the extremities Encourage the patient to practice meticulous foot care Teach the patient or caregiver about wound management Report any potential complications, such as bleeding or thrombosis The nurse must monitor perfusion to the extremities; any abnormalities may indicate further complications or blockage in the arteries. These abnormalities must be reported to the primary health care provider. Foot care is very important in these patients, because they are more susceptible to foot ulcers or other injuries that may lead to limb amputation. The nurse should teach the patient and caregiver about wound management at home. Diabetic patients with peripheral arterial disease (PAD) require extra care after surgery because of the slow recovery process. The nurse should immediately report to the health care provider any potential complications, such as bleeding and thrombosis, because they can lead to surgical site infection (SSI). Because the patient has been taking opioids for more than one year, its withdrawal symptoms can be very dangerous. Therefore, rather than suggesting the patient stop opioids, administering a more aggressive pain reliever would be a better way to deal with opioid tolerance. Diabetic patients with PAD must be encouraged to practice a diet free of refined sugar, in order to maintain the appropriate sugar level. pp. 838-839

The nurse is administering intravenous lidocaine [Xylocaine] to a patient with a ventricular dysrhythmia. Which is the priority nursing intervention to prevent a potential complication with this drug? Obtain a complete blood count. Monitor the electrocardiogram (ECG). Keep naloxone [Narcan] at the bedside. Instruct the patient to report any chest pain.

Monitor the electrocardiogram (ECG). Continuous electrocardiogram (ECG) monitoring is required during lidocaine [Xylocaine] infusions to evaluate cardiac response and adjust dosage accordingly and detect toxicity. Blood counts are not necessary, because lidocaine [Xylocaine] is not linked to blood dyscrasias. Preferably Lidocaine [Xylocaine] is given intravenously (IV) rather than intramuscularly (IM). Sudden onset of chest pain is a sign of arterial embolism, which is a possible adverse effect of quinidine, not lidocaine [Xylocaine]. Naloxone [Narcan] is a reversal agent for opioids and is not used with lidocaine [Xylocaine].

If someone cannot tolerate statin, what will symptoms be? pt. teaching statin

Muscle pain, statin is abnormally breaking down muscle take at night, avoid grapefruit

A patient with angina pectoris asks the nurse about the cause of the pain. The nurse explains that the pain is primarily produced by: Atherosclerosis Myocardial ischemia Movement of a thromboembolus Coronary artery vasoconstriction

Myocardial ischemia The pain of angina pectoris is caused by an inadequate oxygen supply to the myocardium, resulting in ischemia. The other answer options may lead to myocardial ischemia but are secondary causes. p. 741

A patient comes to the clinic and is diagnosed with gouty arthritis. When the nurse looks over the patient's medication list, what medication could have caused this adverse effect? Ezetimibe [Zetia] Gemfibrozil [Lopid] Niacin (nicotinic acid) Colesevelam [Welchol]

Niacin (nicotinic acid) Niacin (nicotinic acid) can elevate blood levels of uric acid. Colesevelam, ezetimibe, and gemfibrozil do not elevate blood levels of uric acid. p. 572

The nurse is caring for a patient in the recovery area following a femoral-posterior tibial bypass graft. Which interventions should the nurse perform for the patient? Take ankle-brachial index (ABI) measurement. Obtain palpable pulses. Check sensation and movement. Inspect operative extremity every 15 minutes. Place the patient in a knee-flexed position.

Obtain palpable pulses. Check sensation and movement. Inspect operative extremity every 15 minutes. When caring for the patient in the recovery area, the nurse should obtain palpable pulses, check sensation and movement of extremities, and inspect the operative extremity every 15 minutes. Postoperative ABI measurements are not recommended, because they place the patient at risk for graft thrombosis. In the recovery area, the patient is not placed in a knee-flexed position; this position is adopted only during exercise one day postsurgery in the absence of complications. p. 838

The nurse is caring for a patient receiving clopidogrel [Plavix] to prevent blockage of coronary artery stents. Which other drug on the patient's medication administration record may reduce the antiplatelet effects of clopidogrel [Plavix]? Aspirin Warfarin [Coumadin] Omeprazole [Prilosec] Acetaminophen [Tylenol]

Omeprazole [Prilosec] Omeprazole [Prilosec] and other proton pump inhibitors may reduce the antiplatelet effects of clopidogrel [Plavix]. Patients sometimes take them to reduce gastric acidity and the risk of gastrointestinal bleeding. p. 614

The nurse does not have information about a patient's typical systolic blood pressure. The nurse is preparing to take the patient's blood pressure using a sphygmomanometer and a stethoscope. What action should the nurse take? Replace the cuff on the patient's arm with slightly larger-sized cuff Palpate the brachial pulse and inflate the cuff until the pulse ceases Apply extra pressure on the cuff manually to measure blood pressure Discontinue blood pressure measurement and try to obtain the information within the next hour

Palpate the brachial pulse and inflate the cuff until the pulse ceases While measuring blood pressure with the sphygmomanometer and a stethoscope, if systolic blood pressure is not known, then the nurse should palpate the brachial pulse and inflate the cuff until the pulse ceases. Using a larger-sized cuff cannot give accurate results for blood pressure. Applying extra pressure can increase the pressure on the brachial artery, which can give inaccurate test results. When a blood pressure measurement is scheduled, the nurse should be timely and take the patient's blood pressure, using the appropriate technique. p. 690

Based on the lipid profile reports of four patients in a health care setting, which patient should the nurse expect to have a prescription for cholestyramine? Patient with a triglyceride level of 138 mg/dL Patient with a total cholesterol level of 180 mg/dL Patient with high-density lipoprotein (HDL) cholesterol of 60 mg/dL Patient with low-density lipoprotein (LDL) cholesterol of 190 mg/dL

Patient with low-density lipoprotein (LDL) cholesterol of 190 mg/dL Patients with LDL cholesterol levels greater than 160 mg/dL are at a risk for acquiring coronary artery disease and would benefit from receiving cholestyramine. Patients with a triglyceride level of 138 mg/dL are not at a risk for coronary heart disease and cholestyramine is not indicated. Patients with total cholesterol levels less than 200 mg/dL do not require drug treatment because they are not at risk of developing coronary heart disease. Patients with HDL less than 40 mg/dL are at a risk of developing coronary heart disease and must be treated with appropriate drugs. p. 739

The ECG monitor of a patient in the cardiac care unit after a myocardial infarction indicates ventricular fibrillation. What would be the nurse's immediate action? Perform cardiopulmonary resuscitation (CPR) Administer intravenous (IV) amiodarone Perform synchronized cardioversion Prepare for insertion of a temporary transvenous pacemaker

Perform cardiopulmonary resuscitation (CPR) Treatment consists of immediate initiation of CPR and advanced cardiac life support (ACLS), with the use of defibrillation and definitive drug therapy (e.g., epinephrine, vasopressin). There should be no delay in using a defibrillator once available. Amiodarone, cardioversion, and temporary pacemakers are not used to treat ventricular fibrillation. p. 801

A patient who uses nonsmoking tobacco complains of chest pain when at rest. His or her electrocardiogram (ECG) shows ST segment elevation. Which condition is the patient experiencing? Silent ischemia Angina decubitus Prinzmetal's angina Chronic stable angina

Prinzmetal's angina Prinzmetal's angina often occurs at rest, usually in response to spasms of a major coronary artery due to nicotine, which cause the release of catecholamines such as epinephrine and norepinephrine. When the spasms occur, the patient experiences pain and ST segment elevation. Silent ischemia refers to the ischemia that occurs in the absence of any subjective symptoms. Angina decubitus is chest pain that occurs only when the patient is lying down. Chronic stable angina does not occur at rest and is triggered by physical exertion. p. 742

Which statement related to radiofrequency catheter ablation procedure is accurate? The ablation procedure has a high rate of complications. Ablation therapy is done before electrophysiological study (EPS) has identified the source of the dysrhythmia. Radiofrequency catheter ablation therapy is considered definitive treatment of severe bradycardia heart rhythms. Radiofrequency catheter ablation therapy uses electrical energy to remove problematic areas of the heart's conduction system

Radiofrequency catheter ablation therapy uses electrical energy to remove problematic areas of the heart's conduction system Radiofrequency catheter ablation therapy uses electrical energy to "burn" or ablate areas of the conduction system as definitive treatment of tachydysrhythmias. Ablation therapy is done after EPS has identified the source of the dysrhythmia. The ablation procedure is successful with a low complication rate. p. 805

Why can't a patient recieve fluoxetine & ranolazine?

Ranolazine is a sodium current inhibitor used to treat chronic angina. It is known to prolong the QT interval as is fluoxetine, so the medication regimen of Patient D needs correction. Patient A is intolerant of angiotensinII converting enzyme inhibitors, and therefore, can use an angiotensin II receptor blockers such as losartan to reduce the incidence of cardiovascular events. Patient B has a contraindication to the beta blocker, nadolol, can use a calcium channel blocker such as felodipine. For Patient C, a calcium channel blocker such as felodipine and nitrates such as isosorbide dinitrate are used in the treatment of Prinzmetal's angina. p. 745

What changes are evident on a cardiac monitor for a patient who had a myocardial infarction (MI)? ST segment is elevated. T wave is normal. Q wave is wide and deep. Physiologic Q wave is present. Q wave is greater than 0.03 second in duration.

ST segment is elevated. Q wave is wide and deep. Q wave is greater than 0.03 second in duration. The ECG changes are prominent after a myocardial injury. The ST segment is usually elevated and is considered significant if it is placed 1 mm or more above the isoelectric line. However, this should be at least present in two continuous leads. The Q wave is wide and deep and is known as the pathologic Q wave. It is also greater than 0.03 second in duration. The T wave is inverted and occurs within hours following the infarction and may persist for months. A physiologic Q wave is the first negative deflection following the P wave. It is normally short and narrow. p. 807

The nurse is caring for patients who underwent coronary artery bypass graft surgery. The nurse identifies that the patients with which type of graft would be best helped by postoperative statin and antiplatelet therapies? Radial artery graft Saphenous vein graft Gastroepiploic artery graft Internal mammary artery graft

Saphenous vein graft Coronary artery bypass graft surgery (CABG) involves the replacement of conduits that transport blood between the aorta and the coronary artery. A patient with a saphenous vein graft may develop intimal hyperplasia, which contributes to stenosis and graft occlusions. This patient should receive antiplatelet therapy and statins after surgery to improve vein graft patency. A patient with radial artery CABG should receive calcium channel blockers and long-acting nitrates to control coronary spasms. A patient with gastroepiploic artery CABG generally has a high graft patency rate; the chances of graft-related problems are very rare. A patient with CABG of the internal mammary artery has an average graft patency of more than 90 percent, even after 10 years. A patient with high graft patency rates may not require any medication to maintain the patency of the graft. p. 752

A patient has a heart rate of 150 beats per minute. An electrocardiogram shows a normal P wave preceding each QRS complex. The nurse recognizes that the patient is most likely experiencing what condition? Atrial fibrillation Sinus tachycardia Ventricular fibrillation Premature atrial contraction

Sinus tachycardia Sinus tachycardia inhibits the vagus nerve or stimulates the sympathetic nervous system. This causes an increase in the heart rate to about 101 beats to 200 beats per minute. The electrocardiographic study of sinus tachycardia shows a normal P wave preceding each QRS complex with normal time and duration. In atrial fibrillation, the P waves are chaotic and fibrillatory and the QRS complex is normal. The electrocardiographic study of ventricular fibrillation elicits the absence of P waves and the PR interval and QRS interval cannot be measured. In premature atrial contraction, there are distorted P waves in the ECG. pp. 793-795

A nurse teaching self-care measures to a patient who has undergone peripheral artery bypass surgery finds that the patient's condition will be aggravated. Which action supports the nurse's conclusion? Sitting cross-legged Reducing salt intake Eating food high in protein Filing toenails straight across

Sitting cross-legged The patient who has undergone peripheral artery bypass surgery should not sit with legs crossed. It can increase pain and edema and increase the risk of venous thrombosis. Reducing salt intake maintains normal blood pressure. Protein plays an important role in healing surgical wounds and ensures early recovery from surgery. Filing toenails straight across will reduce the risk of injury. p. 839

A 62-year-old Hispanic male patient with diabetes mellitus has been diagnosed with peripheral artery disease (PAD). The patient is a smoker and has a history of gout. On what should the nurse focus the teaching to prevent complications for this patient? Gender Smoking Ethnicity Comorbidities

Smoking is the most significant risk factor for this patient. PAD is a marker of advanced systemic atherosclerosis. Therefore, tobacco cessation is essential to reduce PAD progression, cardiovascular disease (CVD) events, and mortality. Being male or Hispanic are not risk factors for PAD. Diabetes mellitus and hyperuricemia also are risk factors. p. 836

Which treatment may help prevent amputation in patients with critical limb ischemia? Nifedipine Pseudoephedrine Spinal cord stimulation Providing oxygen supply

Spinal cord stimulation Spinal cord stimulation helps in managing pain and prevents the need for amputation in patients with critical limb ischemia. Nifedipine is used to reduce severity of vasospastic attacks. Pseudoephedrine should not be given to patients with critical limb ischemia because it may produce vasoconstrictive effect. Oxygen supply is recommended to treat myocardial ischemia. p. 837

The primary healthcare provider prescribes niacin (nicotinic acid) for a patient who has hyperlipidemia. What will the nurse assess for while caring for this patient? Symptoms of pruritus Symptoms of constipation Symptoms of muscle pain Symptoms of nausea and vomiting

Symptoms of pruritus The nurse should monitor the patient for adverse effects of niacin (nicotinic acid) such as abdominal discomfort, cutaneous flushing, and pruritus. Constipation is an adverse effect produced by HMG-CoA reductase inhibitors and bile acid sequestrants. Muscle pain is the most serious adverse effect of statins. Nausea and vomiting are adverse effects of HMG-CoA reductase inhibitors and bile acid sequestrants. p. 572

What should the nurse expect to be prescribed for the patient with paroxysmal supraventricular tachycardia receiving intravenous adenosine who becomes hemodynamically unstable? β-adrenergic blockers Calcium channel blockers Catheter ablation therapy Synchronized cardioversion

Synchronized cardioversion Paroxysmal supraventricular tachycardia is a dysrhythmia starting in an ectopic focus anywhere above the bifurcation of the bundle of His. The standard drug of choice to treat paroxysmal supraventricular tachycardia is intravenous (IV) adenosine. Sometimes the drug therapy is ineffective and the patient becomes hemodynamically unstable. For patients who are unresponsive to treatment, synchronized cardioversion is used. Synchronized cardioversion is low energy shock, which uses a sensor to deliver electricity that is synchronized with the peak of the QRS complex. Drug therapy is not effective for such patients. Therefore, β-adrenergic blockers and calcium channel blockers do not improve paroxysmal supraventricular tachycardia. Catheter ablation therapy is used in patients with Wolff-Parkinson-White syndrome who have recurring paroxysmal supraventricular tachycardia (PSVT). p. 795

A nurse is reviewing an electrocardiogram that was recorded for a patient with an electrolyte imbalance. Which wave is affected by alterations in the electrolyte levels? P wave Q wave S wave T wave

T Wave The T wave represents ventricular repolarization in an electrocardiogram. It is always upright in a normal electrocardiogram. Disturbances in T waves can occur due to electrolyte imbalances, ischemia, and infarction. Disturbances in the P wave can be due to alterations in atrial conduction. Disturbances in the Q wave can occur due to myocardial infraction. Disturbances in the S wave do not affect the normal functioning of heart. p. 791

Which statement made by the student nurse indicates the need for additional teaching about electrocardiogram leads? Leads I, II and III are bipolar. Leads aVR, aVL, and aVF are unipolar. Six bipolar leads measure the electrical forces in the horizontal plane. The 12-lead electrocardiogram (ECG) shows conduction disturbances and electrolytic imbalance.

The 12-lead electrocardiogram (ECG) shows conduction disturbances and electrolytic imbalance. The ECG is a graphic tracing of the electrical impulses produced in the heart. The 12-lead ECG is a representation of the heart's electrical activity recorded from electrodes on the body surface. The 12-lead ECG shows conduction disturbances and electrolytic imbalance. Leads I, II and III are bipolar in nature and indicate that they possess both positive and negative charges. Leads aVR, aVL, and aVF are unipolar positive. The 12-lead ECG shows conduction disturbances and electrolytic imbalances or drug toxicity. The six leads that measure the electrical forces in the horizontal plane are unipolar leads but are not bipolar leads. p. 788

While observing the ECG characteristics of a patient with a third-degree heart block, what changes should the nurse expect to find? The PR interval is variable. There are a greater number of P waves present. The atrial rate is more than 100 beats per minute. The ventricular rate is irregular. The atrial and ventricular rhythms are regular but unrelated.

The PR interval is variable. There are a greater number of P waves present. The atrial and ventricular rhythms are regular but unrelated. A third-degree block is often called a complete heart block because no atrial impulses are conducted through the AV node to the ventricles. In such situations, the atria and ventricles beat independently because the AV node is completely blocked to the sinus impulse and, therefore, it is not conducted to the ventricles. One of the characteristics of a third-degree heart block is that the P waves have no association with the QRS complexes and appear throughout the QRS waveform. The atrial and ventricular rhythms are regular, but these are not related to each other. The atrial rate is usually a sinus rate of 60 to 100 beats per minute. p. 798

The nurse assesses the patient's prothrombin (PT) time to determine the effectiveness of anticoagulant therapy and notes that it is 32 seconds. How will the nurse interpret this value? The PT is within normal limits. The PT is significantly elevated. The PT is significantly decreased. The PT is inadequate to evaluate treatment.

The PT is significantly elevated. The normal control PT value ranges from 11 to 13 seconds. The target therapeutic level of anticoagulation is 1.5 times the control value or about 18 seconds. Therefore, 32 seconds is considered a significantly elevated value. pp. 604-605

The nurse is caring for a patient who is scheduled to begin warfarin treatment and is currently being treated with amiodarone. Based on this information, the nurse anticipates which change will be made to the medication regimen? The dosage of the warfarin will be increased. The dosage of the warfarin will be decreased. The dosage of the amiodarone will be decreased. The dosage of the amiodarone will be increased.

The dosage of the warfarin will be decreased. When amiodarone is given along with warfarin therapy, it is recommended that the warfarin dose be cut in half. p. 606, Table 52-4

The nurse is caring for a patient who is being treated with dabigatran [Pradaxa]. The nurse is monitoring the patient's laboratory test results and notes that the creatinine clearance is 25 mL/min. Based on this information, the nurse anticipates which change to the medication regimen? The medication will be stopped completely. The dose of the medication will be increased. The dose of the medication will be decreased. The dose of the medication will be unchanged.

The dose of the medication will be decreased. The normal dose of dabigatran [Pradaxa] is 150 mg twice daily, but it must be reduced to 75 mg daily if the creatinine clearance is less than 30 mL/min. pp. 608-609

Which statement best describes the electrical activity of the heart represented by measuring the PR interval on the ECG? The length of time it takes to depolarize the atrium The length of time it takes for the atria to depolarize and repolarize The length of time for the electrical impulse to travel from the sinoatrial (SA) node to the Purkinje fibers The length of time it takes for the electrical impulse to travel from the SA node to the atrioventricular (AV) node

The electrical impulse in the heart must travel from the SA node through the AV node and into the Purkinje fibers for synchronous atrial and ventricular contraction to occur. When measuring the PR interval (the time from the beginning of the P wave to the beginning of the QRS), the nurse is identifying the length of time it takes for the electrical impulse to travel from the SA node to the Purkinje fibers. The P wave represents the length of time it takes for the impulse to travel from the SA node through the atrium, causing depolarization of the atria (atrial contraction). Atrial repolarization occurs during ventricular depolarization and is hidden by the QRS complex. The length of time it takes for the electrical impulse to travel from the SA node to the AV node is the flat line between the end of the P wave and the beginning of the Q wave on the ECG and usually is not measured. p. 791

The patient is receiving warfarin therapy, and the nurse finds the international normalized ratio (INR) to be 4.0. How will the nurse interpret this finding? The level is within the expected target therapeutic level of anticoagulation. The level is outside the expected target therapeutic level of anticoagulation; it is too low. The level is outside the expected target therapeutic level of anticoagulation; it is too high. The level cannot be interpreted without knowing the prothrombin time and the activated partial thromboplastin time (aPTT) value.

The level is outside the expected target therapeutic level of anticoagulation; it is too high. Target levels of the INR typically range from 2 to 3 with an average of 2.5; the average may increase to 3.0 for individuals taking warfarin for treatment of recurring systemic clots or emboli or those who have mechanical heart valves. p. 605

The nurse is caring for a patient who is undergoing treatment with heparin therapy. The nurse assesses the patient's activated partial thromboplastin time (aPTT) level and finds it to be 98 seconds. How will the nurse interpret this finding? The level is within the expected target therapeutic level of anticoagulation. The level is outside the expected target therapeutic level of anticoagulation; it is too low. The level is outside the expected target therapeutic level of anticoagulation; it is too high. The level cannot be interpreted without knowing the prothrombin time and the international normalized ratio (INR).

The level is outside the expected target therapeutic level of anticoagulation; it is too high. The target therapeutic level of anticoagulation is between 45 and 70 seconds for the aPTT value. p. 601

A patient undergoing treatment for dysrhythmia is provided with a Holter monitor. Which information or instructions should the nurse provide to the patient using the Holter monitor? The patient should activate the monitor when experiencing symptoms. The monitor records electrocardiogram (ECG) when the patient is ambulatory. The patient should record activities and symptoms in a diary. The monitor evaluates heart rhythm during exercise. The monitor records ECG when the patient performs daily activities.

The monitor records electrocardiogram (ECG) when the patient is ambulatory. The patient should record activities and symptoms in a diary. The monitor records ECG when the patient performs daily activities. The Holter monitor continuously records the ECG while the patient is ambulatory and performing daily activities. The patient should keep a diary and record activities and any symptoms. Event monitors are recorders that the patient activates only when experiencing symptoms. Exercise treadmill testing evaluates the patient's heart rhythm during exercise. p. 792

The nurse is preparing to administer an anticoagulant to a patient. Which action, if observed, is in error? The nurse administers heparin subcutaneously to a patient. The nurse administers warfarin [Coumadin] orally to a patient. The nurse administers dabigatran [Pradaxa] orally to a patient. The nurse administers enoxaparin [Lovenox] intramuscularly to a patient.

The nurse administers enoxaparin [Lovenox] intramuscularly to a patient. The nurse should not administer an anticoagulant intramuscularly as this would cause a high risk of bleeding into the muscle and a large hematoma to form at the injection site. The other medications can be administered via the routes listed. p. 619

A diabetic patient underwent an ankle-brachial index (ABI) test. The result of the test is 1.10. How should the nurse interpret the test result? The patient has peripheral arterial disease The patient has normal ABI The patient has falsely elevated ABI The patient has borderline ABI

The patient has falsely elevated ABI Ankle-brachial index (ABI) test is a screening tool for peripheral arterial disease. An ABI of 1.10 is a normal value in healthy adults. However, in diabetic patients the arteries are calcified and noncompressible, which often result in a falsely elevated ABI. An ABI of 1.10 does not indicate PAD. The value can be considered normal in healthy adults, but not in diabetic patients, because their blood vessels are calcified and stiff. A borderline ABI has a value of 0.91 to 0.99. pp. 835-836

An elderly patient with hypertension and hyperlipidemia who has been prescribed a statin medication comes for a follow-up visit after 4 months of therapy. The patient's lab reports show elevated blood cholesterol levels and the urine examination reveals rhabdomyolysis. What could be the reasons for this condition? . The patient is not responding to the treatment. The patient is taking cyclosporine along with statins. The patient is eating fiber rich food along with statins. The patient is taking grapefruit juice along with statins. The patient is taking amiodarone [Cordarone] along with statins.

The patient is taking cyclosporine along with statins. The patient is taking grapefruit juice along with statins. The patient is taking amiodarone [Cordarone] along with statins. Grapefruit juice, amiodarone [Cordarone], and cyclosporine inhibit the metabolic protein CYP3A4 and thus decrease the metabolism of the statins. This leads to sustained blood levels of unmetabolized statins and rhabdomyolysis. As statins are not metabolized completely, less of the drug is available in the patient to decrease the blood cholesterol levels; the patient will still show elevated blood cholesterol levels with rhabdomyolysis. Statins are highly effective in reducing cholesterol levels, and it is unlikely that the patient is not responding to the therapy. Fiber intake does not affect the metabolic protein CYP3A4. It is unlikely that these symptoms are caused due to the intake of fiber rich food. p. 570

The nurse is teaching measures to be followed by a patient. Which action indicates effective learning in a patient who is diagnosed with aortic aneurysm? The patient avoids kale in the diet. The patient stops eating red meat. The patient stops smoking tobacco. The patient avoids eating salted fish. The patient avoids broccoli in the diet.

The patient stops eating red meat. The patient stops smoking tobacco. The patient avoids eating salted fish. The patient should take steps to maintain normal blood pressure, which include avoiding eating red meat and tobacco. Eating salted fish also can increase blood pressure and should be avoided. Kale and broccoli are contraindicated for someone who is receiving anticoagulant therapy, but not for a patient with aortic aneurysm. p. 842

Which patient does the nurse anticipate will receive alteplase [Activase] therapy? The patient with peptic ulcer disease The patient with a gastrointestinal bleed The patient with severe chest pain for the past 2 hours The patient with a local thrombosis from a peripheral IV

The patient with severe chest pain for the past 2 hours The best candidate for therapy with alteplase is the patient who complains of new-onset chest pain. It is likely the chest pain is caused by a clot in a coronary artery. Thrombolytic therapy could dissolve the clot and alleviate the myocardial ischemia and the pain. The patients with peptic ulcer disease and gastrointestinal bleeding would have an increased risk of bleeding with this therapy. The patient with a local thrombosis will not need treatment because the thrombosis is typically small and is reabsorbed with local therapy. p. 617

Which statement regarding the anatomical characteristics of the heart is true? The right and the left atria are similar in size. The atrial myocardium is thicker than that of the ventricles. The right ventricular wall is three times thicker than the left ventricular wall. The thickness of the left ventricle is necessary to pump the blood into the systemic circulation.

The thickness of the left ventricle is necessary to pump the blood into the systemic circulation. The left ventricle is thicker because it needs to pump the blood into circulation. The right and left atria are different sizes and have different wall thicknesses. The atrial myocardium is thinner than that of the ventricles. The left ventricular wall is two or three times thicker than the right ventricular wall. p. 687

Which statement by a patient demonstrates the need for further teaching regarding atrial fibrillation? This condition is always reversible A possible complication is a stroke. Atrial fibrillation can be a permanent condition. Anticoagulation is necessary while I am in atrial fibrillation.

This condition is always reversible Atrial fibrillation can be permanent, and anticoagulation with warfarin or newer anticoagulants is necessary to prevent a stroke. The condition is not always reversible. p. 541

The nurse should teach a patient with intractable atrial fibrillation about which characteristic of amiodarone [Cordarone]? This is a first-line drug. This drug causes hypertension. This drug has some severe toxicities. This drug treats only ventricular dysrhythmias.

This drug has some severe toxicities. Amiodarone [Cordarone] is a very effective drug approved for the treatment of life-threatening ventricular dysrhythmias; however, it is also effective for treatment of atrial fibrillation. This drug is associated with many toxicities, such as cardiotoxicity, thyroid toxicity, liver toxicity, and pulmonary toxicity. The medication is not a first-line drug. It is used to treat patients who have not responded to other medications. p. 548

The nurse is caring for a patient who is being treated with amiodarone [Cordarone]. After 6 weeks on the medication, lab work is drawn on the patient and shows evidence of hypothyroidism developing. How should the nurse interpret this information? This is indicative of a toxic dosage of the medication. This is an expected adverse reaction to the medication. This is indicative of an inadequate dosage of the medication. The patient is developing an anaphylactic reaction to the medication.

This is an expected adverse reaction to the medication. Hypothyroidism or hyperthyroidism may develop as a result of taking amiodarone [Cordarone] as a result of its lipophilic nature and the use of iodine in its chemical structure. p. 547

What does the T wave in the electrocardiogram represent? Time taken for ventricular repolarization. Time taken for depolarization of both ventricles. Time between ventricular depolarization and repolarization. Time for the passage of the electrical impulse through the atrium.

Time taken for ventricular repolarization. The electrocardiogram is commonly used to detect abnormal heart rhythms and to investigate the cause of chest pains. The T wave in the electrocardiogram should be upright; it represents time for ventricular repolarization. Time taken for depolarization of both ventricles is represented by QRS interval. Time between ventricular depolarization and repolarization is represented by ST segment. Time for the passage of the electrical impulse through the atrium is represented by P wave. p. 791

What is the reason behind placing the bed in the reverse Trendelenburg position while the nurse cares for a patient with critical limb ischemia? To reduce restenosis To prevent skin maceration To reduce the risk of infection To increase perfusion to the lower extremities

To increase perfusion to the lower extremities The patient with critical limb ischemia has a risk of edema. Placing the patient's bed in the reverse Trendelenburg position will increase perfusion to the lower extremities and reduce the risk of edema. Placing the patient's bed in the reverse Trendelenburg position does not affect restenosis. Keeping the patient's feet dry can prevent skin maceration. Maintaining hygienic conditions and covering ulcers with dry and sterile dressings reduces the risk of infection. p. 837

The nurse is caring for a patient who had insertion of a temporary lumbar drain after an endovascular dissection repair. What does the nurse explain to the patient that the benefit of the drain is? To reduce pain To prevent paralysis To prevent infection To stimulate angiogenesis

To prevent paralysis Repair of endovascular dissection may cause accumulation of cerebrospinal fluid, resulting in spinal cord edema. Temporary insertion of a lumbar drain helps remove the cerebrospinal fluid and reduce spinal cord edema, thus preventing paralysis. Analgesics are administered to reduce surgical pain. Antibiotics are administered to prevent infection. Gene therapy is used to stimulate angiogenesis. p. 846

A 59-year-old man has presented to the emergency department with chest pain. What component of the patient's blood work is most clearly indicative of a myocardial infarction (MI)? Creatine kinase (CK)-MB Troponin Myoglobin C-reactive protein (CRP)

TroponinTroponin is the biomarker of choice in the diagnosis of MI, with sensitivity and specificity that exceed those of CK-MB and myoglobin. CRP levels are not used to diagnose acute MI. pp. 698-699

Angina Pectoris- Variant (Prinzmetal)

caused by coronary arterial spasms, usually @ same time of day, same amt. of time, rest does not decrease pain, no damage

The nurse recognizes which cardiac dysrhythmia as life threatening and necessitating immediate intervention? Sinus tachycardia Atrial fibrillation Junctional tachycardia Ventricular fibrillation

Ventricular fibrillation Menu Elsevier Adaptive Quizzing Final 36% Score 11/30 questions answered correctly Score = 36%: 11 out of 30 questions answered correctly Completed on 9/24/2017 6:28 pm Incorrect (19) A patient with a newly inserted pacemaker receives discharge instructions. Which patient statement indicates that further teaching is required? "I should avoid using microwave ovens." "I should avoid standing near antitheft devices." "I should avoid direct blows to the pacemaker site." "I should avoid close proximity to high-output electric generators." Microwaves do not interfere with a pacemaker's function and can be used safely. Electric signals from antitheft devices can affect pacemaker functioning. The patient should avoid direct blows to the pacemaker site to reduce pressure at the site. Electric signals from high-output electric generators can move the pacemaker from its position and affect its functioning. p. 806 Which action does flecainide have on the heart? Decreases conduction Decreases automaticity Accelerates repolarization Reduces myocardial contractility Flecainide is a class IC sodium channel blocker; it decreases impulse conduction in patients. Mexiletine is a class IB sodium channel blocker that accelerates repolarization. β-adrenergic blockers like esmolol decrease the automaticity of the sinoatrial node. Myocardial contractility is reduced with diltiazem, a calcium channel blocker. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. p. 801 A patient has the following electrocardiogram (ECG) tracing. What should a nurse do? No intervention is necessary. Continue monitoring. Call the primary health care provider recommending a blood sample be drawn to evaluate electrolyte status. Notify the primary health care provider that the ECG tracing is showing second degree atrioventricular (AV) Block Type 1. Call a Code Blue. The patient is in a first degree AV Block, a benign rhythm. It is not necessary to evaluate electrolytes. The patient is not in a lethal rhythm, so do not call a Code Blue. No interventions are necessary. p. 798 A patient with a heart rate of 120 beats/minute is prescribed antidysrhythmic drugs. What additional diagnostic test does the nurse expect to be prescribed for this patient? Holter monitoring Electrophysiologic study Exercise treadmill testing Signal-averaged electrocardiogram An electrophysiologic study identifies the causes of heart blocks, tachydysrhythmias, bradydysrhythmias, and syncope. It can also locate accessory pathways and determine the effectiveness of antidysrhythmic drugs. A Holter monitor is used to record electrocardiogram when the patient is ambulatory and performing daily activities. Exercise treadmill testing evaluates the patient's heart rhythm during exercise. Signal-averaged electrocardiogram identifies the late potential if the patient is at risk of developing serious arrhythmias. p. 792 A patient is admitted for placement of a permanent pacemaker. Which health problem does the nurse suspect in this patient? Heart failure Tachydysrhythmias Acute inferior myocardial infarction Complication from open-heart surgery A permanent pacemaker is indicated in a patient with heart failure. A temporary pacemaker is indicated in patients recovering from tachydysrhythmias, inferior myocardial infarction, and open-heart surgery. p. 804 While observing the ECG characteristics of a patient with a third-degree heart block, what changes should the nurse expect to find? The PR interval is variable. There are a greater number of P waves present. The atrial rate is more than 100 beats per minute. The ventricular rate is irregular. The atrial and ventricular rhythms are regular but unrelated. A third-degree block is often called a complete heart block because no atrial impulses are conducted through the AV node to the ventricles. In such situations, the atria and ventricles beat independently because the AV node is completely blocked to the sinus impulse and, therefore, it is not conducted to the ventricles. One of the characteristics of a third-degree heart block is that the P waves have no association with the QRS complexes and appear throughout the QRS waveform. The atrial and ventricular rhythms are regular, but these are not related to each other. The atrial rate is usually a sinus rate of 60 to 100 beats per minute. STUDY TIP: Avoid planning other activities that will add stress to your life between now and the time you take the licensure examination. Enough will happen spontaneously; do not plan to add to it. p. 798 A nurse works in a critical care unit. When attending to a patient, the nurse finds that the patient has developed atrial fibrillation. What should be the treatment for this patient? Electrical cardioversion Oxygen therapy Anticoagulation therapy Atropine injection Prepare for radiofrequency catheter ablation Electrical cardioversion converts the atrial fibrillation into normal sinus rhythm. If a patient is in atrial fibrillation for more than 48 hours, anticoagulation therapy with warfarin will be required for three to four weeks. This should commence before the cardioversion and has to be continued for several weeks after successful cardioversion. For patients with drug-refractory atrial fibrillation or those who do not respond to electrical conversion, radiofrequency catheter ablation may be done. Administering oxygen may not be required. Atropine injection is not required in atrial fibrillation. However, it may be required in cases of certain atrioventricular blocks. Test-Taking Tip: Never leave a question unanswered. Even if answering is no more than an educated guess on your part, go ahead and mark an answer. You might be right, but if you leave it blank, you will certainly be wrong and lose precious points. p. 796 A patient undergoing treatment for dysrhythmia is provided with a Holter monitor. Which information or instructions should the nurse provide to the patient using the Holter monitor? The patient should activate the monitor when experiencing symptoms. The monitor records electrocardiogram (ECG) when the patient is ambulatory. The patient should record activities and symptoms in a diary. The monitor evaluates heart rhythm during exercise. The monitor records ECG when the patient performs daily activities. The Holter monitor continuously records the ECG while the patient is ambulatory and performing daily activities. The patient should keep a diary and record activities and any symptoms. Event monitors are recorders that the patient activates only when experiencing symptoms. Exercise treadmill testing evaluates the patient's heart rhythm during exercise. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. p. 792 A nurse is performing an initial assessment on a patient. The electrocardiogram (ECG) tracing is as follows. The nurse recognizes that this type of tracing may result from an electrolyte imbalance or a medication. What is another cause for the abnormality? Myocardial infarction Myocardial ischemia Fluid overload Dehydration Decreased blood and oxygen to the heart muscle (myocardial ischemia) results in ST segment depression. Myocardial infarction causes ST elevation. Fluid overload and dehydration often affect the heart rate, but not ST segment position on the ECG tracing. p. 806 Which patient teaching points should the nurse include when providing discharge instructions to a patient with an implantable cardioverter-defibrillator (ICD)? Avoid or limit air travel. Avoid large magnets and strong electromagnetic fields. Obtain and wear a Medic Alert ID or bracelet at all times. Avoid lifting arm on ICD side above shoulder until approved. Do not walk through antitheft devices in doorways of stores and public buildings. Patients with ICDs need to avoid large magnets and strong electromagnetic fields, because they may interfere with ICD function. These patients need to obtain and wear a MedicAlert ID or bracelet at all times, and avoid lifting their arms on the ICD side above their shoulders until approved. These patients do not need to avoid air travel; they can walk through antitheft devices at a normal pace but should not stand next to them. p. 803 A nurse finds that a patient has an atrial rate of 450 beats per minute and a ventricular rate of 150 beats per minute. What condition is the patient likely experiencing? Atrial flutter Atrial fibrillation Ventricular fibrillation Premature ventricular contractions Atrial fibrillation is characterized by alterations in electrical conductivity of the atrium. The atrial rate is as high as 350 beats per minute to 600 beats per minute. Atrial fibrillation with controlled ventricular response is observed at a ventricular rate of 60 beats per minute to 100 beats per minute. A ventricular rate above 100 beats per minute is considered as atrial fibrillation with uncontrolled ventricular response. The atrial rate and ventricular rate in atrial flutter occur at the ratio of 2:1. The atrial rate is observed between 200 beats per minute to 350 beats per minute and the ventricular rate occurs at 150 beats per minute. Ventricular fibrillation elicits dysrhythmia and P wave and QRS complex cannot be predicted. Premature ventricular contractions elicit dysrhythmia with deflections in the heart rate. pp. 796-797 The nurse is reviewing prescriptions of four patients. What does the nurse infer from this review? Patient A has atrial fibrillation. Patient B has sinus tachycardia. Patient D has sinus bradycardia. Patient C has junctional escape rhythm. A patient with junctional escape rhythm shows a heart rate in the range of 40 to 60 beats/minute. Atropine increases the ventricular rate and can effectively improve the junctional escape rhythm in patient C. Atrial fibrillation in patient A is treated with diltiazem. Sinus tachycardia can be effectively treated by synchronized cardioversion in patient B. Sinus bradycardia in patient D can be treated by amiodarone. Test-Taking Tip: Chart/exhibit items present a situation and ask a question. A variety of objective and subjective information is presented about the patient in formats such as the medical record (e.g., laboratory test results, results of diagnostic procedures, progress notes, health care provider orders, medication administration records, health history), physical assessment data, and assistant/patient interactions. After analyzing the information presented, the test taker answers the question. These questions usually reflect the analyzing level of cognitive thinking. p. 797 What should the nurse expect to be prescribed for the patient with paroxysmal supraventricular tachycardia receiving intravenous adenosine who becomes hemodynamically unstable? β-adrenergic blockers Calcium channel blockers Catheter ablation therapy Synchronized cardioversion Paroxysmal supraventricular tachycardia is a dysrhythmia starting in an ectopic focus anywhere above the bifurcation of the bundle of His. The standard drug of choice to treat paroxysmal supraventricular tachycardia is intravenous (IV) adenosine. Sometimes the drug therapy is ineffective and the patient becomes hemodynamically unstable. For patients who are unresponsive to treatment, synchronized cardioversion is used. Synchronized cardioversion is low energy shock, which uses a sensor to deliver electricity that is synchronized with the peak of the QRS complex. Drug therapy is not effective for such patients. Therefore, β-adrenergic blockers and calcium channel blockers do not improve paroxysmal supraventricular tachycardia. Catheter ablation therapy is used in patients with Wolff-Parkinson-White syndrome who have recurring paroxysmal supraventricular tachycardia (PSVT). Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills and abilities to choose from the remaining responses. p. 795 How does esmolol affect an ECG? Delaying repolarization Accelerating repolarization Decreasing automaticity of the SA node Slowing the impulse conduction in the AV node Suppressing atrial dysrhythmias through an unknown mechanism Esmolol is a β-adrenergic blocker that decreases the automaticity of the SA node and slows the impulse conduction in the AV node. Esmolol causes prolonged PR intervals. Potassium channel blockers delay repolarization. Class IB sodium channel blockers accelerate repolarization. Esmolol does not suppress atrial dysrhythmias through an unknown mechanism. p. 801 A patient with chest pain has a heart rate of 200 beats/minute and blood pressure of 80/50 mm Hg. The electrocardiogram shows absent P waves. Which medication should the nurse expect to be prescribed for this patient? Intravenous Digoxin Intravenous Atropine Intravenous Vasopressin Intravenous adenosine Paroxysmal supraventricular tachycardia (PSVT) is a dysrhythmia starting in an ectopic focus anywhere above the bifurcation of the bundle of His. The symptoms associated with PSVT include hypotension, palpitations, dyspnea, and angina. In PSVT, the heart rate will be greater than 180 beats/minute and the electrocardiogram will often show a hidden P wave. Intravenous adenosine is the standard drug for paroxysmal supraventricular tachycardia. Digoxin, atropine, and vasopressin are not prescribed for paroxysmal supraventricular tachycardia. Digoxin is used in the treatment of atrial fibrillation. Atropine is used in the treatment of junctional escape rhythm. Vasopressin is used in the treatment of asystole. p. 795 What changes are evident on a cardiac monitor for a patient who had a myocardial infarction (MI)? ST segment is elevated. T wave is normal. Q wave is wide and deep. Physiologic Q wave is present. Q wave is greater than 0.03 second in duration. The ECG changes are prominent after a myocardial injury. The ST segment is usually elevated and is considered significant if it is placed 1 mm or more above the isoelectric line. However, this should be at least present in two continuous leads. The Q wave is wide and deep and is known as the pathologic Q wave. It is also greater than 0.03 second in duration. The T wave is inverted and occurs within hours following the infarction and may persist for months. A physiologic Q wave is the first negative deflection following the P wave. It is normally short and narrow. p. 807 A nurse is reviewing an electrocardiogram that was recorded for a patient with an electrolyte imbalance. Which wave is affected by alterations in the electrolyte levels? P wave Q wave S wave T wave The T wave represents ventricular repolarization in an electrocardiogram. It is always upright in a normal electrocardiogram. Disturbances in T waves can occur due to electrolyte imbalances, ischemia, and infarction. Disturbances in the P wave can be due to alterations in atrial conduction. Disturbances in the Q wave can occur due to myocardial infraction. Disturbances in the S wave do not affect the normal functioning of heart. p. 791 When computing a heart rate from the ECG tracing, the nurse counts 15 of the small blocks between the R waves of a patient whose rhythm is regular. From these data, the nurse calculates the patient's heart rate to be: 60 beats/minute 75 beats/minute 100 beats/minute 150 beats/minute Because each small block on the ECG paper represents 0.04 seconds, 1500 of these blocks represent one minute. By dividing the number of small blocks (15 in this case) into 1500, the nurse can calculate the heart rate in a patient whose rhythm is regular (in this case, 100). Sixty beats/minute, 75 beats/minute, and 150 beats/minute are incorrect answers. STUDY TIP: Do not change your pattern of study. It obviously has contributed to your being here, so it worked. If you have studied alone, continue to study alone. If you have studied in a group, form a study group. p. 789 Which statement best describes the electrical activity of the heart represented by measuring the PR interval on the ECG? The length of time it takes to depolarize the atrium The length of time it takes for the atria to depolarize and repolarize The length of time for the electrical impulse to travel from the sinoatrial (SA) node to the Purkinje fibers The length of time it takes for the electrical impulse to travel from the SA node to the atrioventricular (AV) node The electrical impulse in the heart must travel from the SA node through the AV node and into the Purkinje fibers for synchronous atrial and ventricular contraction to occur. When measuring the PR interval (the time from the beginning of the P wave to the beginning of the QRS), the nurse is identifying the length of time it takes for the electrical impulse to travel from the SA node to the Purkinje fibers. The P wave represents the length of time it takes for the impulse to travel from the SA node through the atrium, causing depolarization of the atria (atrial contraction). Atrial repolarization occurs during ventricular depolarization and is hidden by the QRS complex. The length of time it takes for the electrical impulse to travel from the SA node to the AV node is the flat line between the end of the P wave and the beginning of the Q wave on the ECG and usually is not measured. STUDY TIP: Develop a realistic plan of study. Do not set rigid, unrealistic goals. p. 791 Correct (11) What does the T wave in the electrocardiogram represent? Time taken for ventricular repolarization. Time taken for depolarization of both ventricles. Time between ventricular depolarization and repolarization. Time for the passage of the electrical impulse through the atrium. The electrocardiogram is commonly used to detect abnormal heart rhythms and to investigate the cause of chest pains. The T wave in the electrocardiogram should be upright; it represents time for ventricular repolarization. Time taken for depolarization of both ventricles is represented by QRS interval. Time between ventricular depolarization and repolarization is represented by ST segment. Time for the passage of the electrical impulse through the atrium is represented by P wave. p. 791 A patient has a heart rate of 150 beats per minute. An electrocardiogram shows a normal P wave preceding each QRS complex. The nurse recognizes that the patient is most likely experiencing what condition? Atrial fibrillation Sinus tachycardia Ventricular fibrillation Premature atrial contraction Sinus tachycardia inhibits the vagus nerve or stimulates the sympathetic nervous system. This causes an increase in the heart rate to about 101 beats to 200 beats per minute. The electrocardiographic study of sinus tachycardia shows a normal P wave preceding each QRS complex with normal time and duration. In atrial fibrillation, the P waves are chaotic and fibrillatory and the QRS complex is normal. The electrocardiographic study of ventricular fibrillation elicits the absence of P waves and the PR interval and QRS interval cannot be measured. In premature atrial contraction, there are distorted P waves in the ECG. pp. 793-795 A patient with the following ECG tracing is preparing for discharge from the hospital. The discharge medications are warfarin and digoxin. The patient education should include which of the following? Avoid foods containing Vitamin K Take warfarin twice a day Importance of monitoring partial thromboplastin time (PTT) levels Warfarin reduces risk of strokes Notify the primary health care provider of epistaxis Check the pulse before taking warfarin Vitamin K can counteract the effects of warfarin. Therefore, the patient needs to be taught which foods contain Vitamin K. Because warfarin is prescribed for patients in atrial fibrillation because of the risk for clot development in the heart resulting in stroke, heart attack, or pulmonary embolism, it should be included in the patient education. A major side effect of warfarin is bleeding. Therefore, the patient should be taught to notify the primary health care provider if he or she develops nosebleeds. Taking warfarin twice a day is incorrect because this medication is given once a day. Outpatient international normalized ratio (INR), not PTT levels, are required to determine correct dosage of warfarin. It is not necessary for the patient to check his or her pulse before taking warfarin. p. 796 A patient who is on a cardiac monitor is shivering. What should the nurse expect to see on this patient's tracing? Artifact Asystole Atrial flutter Junctional dysrhythmia An artifact is a distortion of the baseline and waveforms seen on the electrocardiogram (ECG). If the patient is shivering or shows any muscle activity, accurate interpretation of the heart rhythm is difficult and artifacts can occur on the monitor. Asystole is the absence of all cardiac electrical activity. Atrial flutter occurs in chronic lung disease or hypertension. Junctional dysrhythmias are associated with an electrolyte imbalance or rheumatic heart disease. Test-Taking Tip: : Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. p. 790 While performing the head-up tilt-test the blood pressure and heart rate in an unconscious patient are unresponsive after 30 minutes. Which treatment does the nurse expect to be prescribed for this patient? IV adenosine IV midazolam IV magnesium IV infusion of low-dose isoproterenol A head-up tilt-test is a procedure used to determine the cause of fainting spells in a patient. In the head-up tilt-test, the patient is placed on a table supported by a belt across the torso and feet. The electrocardiogram and heart rate are recorded continuously and blood pressure is measured every three minutes throughout the test. If the patient's BP and HR responses are abnormal and faintness is reproduced, the test is considered positive. If after 30 minutes there is no response, the table is returned to the horizontal position and an IV infusion of low-dose isoproterenol is started to provoke a response. IV adenosine is the drug used in the treatment of paroxysmal supraventricular tachycardia. IV midazolam is used to sedate a patient before performing synchronized cardioversion. IV magnesium is used to treat polymorphic ventricular tachycardia with a prolonged baseline QT interval. p. 808 The ECG monitor of a patient in the cardiac care unit after a myocardial infarction indicates ventricular fibrillation. What would be the nurse's immediate action? Perform cardiopulmonary resuscitation (CPR) Administer intravenous (IV) amiodarone Perform synchronized cardioversion Prepare for insertion of a temporary transvenous pacemaker Treatment consists of immediate initiation of CPR and advanced cardiac life support (ACLS), with the use of defibrillation and definitive drug therapy (e.g., epinephrine, vasopressin). There should be no delay in using a defibrillator once available. Amiodarone, cardioversion, and temporary pacemakers are not used to treat ventricular fibrillation. p. 801 After synchronized cardioversion, a patient's electrocardiogram (ECG) tracing reveals the following. Which statement by a nurse is accurate? "The cardioversion was successful." "Cardioversion will need to be repeated." "The patient is now in accelerated junctional rhythm." "The ECG tracing indicates hyperkalemia." The patient has converted to a normal sinus rhythm (NSR). The cardioversion was successful. Accelerated junctional rhythm is characterized by an absent P wave and inverted P wave before or following the QRS complex. Hyperkalemia is characterized by a peaked T wave. The T wave in this tracing is normal. p. 790 Which statement related to radiofrequency catheter ablation procedure is accurate? The ablation procedure has a high rate of complications. Ablation therapy is done before electrophysiological study (EPS) has identified the source of the dysrhythmia. Radiofrequency catheter ablation therapy is considered definitive treatment of severe bradycardia heart rhythms. Radiofrequency catheter ablation therapy uses electrical energy to remove problematic areas of the heart's conduction system Radiofrequency catheter ablation therapy uses electrical energy to "burn" or ablate areas of the conduction system as definitive treatment of tachydysrhythmias. Ablation therapy is done after EPS has identified the source of the dysrhythmia. The ablation procedure is successful with a low complication rate. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. p. 805 Which statement made by the student nurse indicates the need for additional teaching about electrocardiogram leads? Leads I, II and III are bipolar. Leads aVR, aVL, and aVF are unipolar. Six bipolar leads measure the electrical forces in the horizontal plane. The 12-lead electrocardiogram (ECG) shows conduction disturbances and electrolytic imbalance. The ECG is a graphic tracing of the electrical impulses produced in the heart. The 12-lead ECG is a representation of the heart's electrical activity recorded from electrodes on the body surface. The 12-lead ECG shows conduction disturbances and electrolytic imbalance. Leads I, II and III are bipolar in nature and indicate that they possess both positive and negative charges. Leads aVR, aVL, and aVF are unipolar positive. The 12-lead ECG shows conduction disturbances and electrolytic imbalances or drug toxicity. The six leads that measure the electrical forces in the horizontal plane are unipolar leads but are not bipolar leads. p. 788 A nurse is caring for a patient experiencing sinus bradycardia. Which drugs are used to treat bradycardia? Atropine Dopamine Adenosine Metoprolol Epinephrine Sinus bradycardia is a condition in which the sinoatrial node elicits a heartbeat at a rate of less than 80 beats per minute. Sinus bradycardia is associated with hypotension, weakness, dizziness, and shortness of breath. It can be treated by the administration of atropine, an anticholinergic drug. Sympathomimetic drugs like dopamine and epinephrine are administered if atropine is ineffective. Beta blockers like adenosine and metoprolol are used in the treatment of sinus tachycardia. pp. 793-794 The nurse recognizes which cardiac dysrhythmia as life threatening and necessitating immediate intervention? Sinus tachycardia Atrial fibrillation Junctional tachycardia Ventricular fibrillation Ventricular fibrillation is a life-threatening dysrhythmia that requires immediate intervention. During ventricular fibrillation, the ventricles are quivering and are no longer able to contract to produce effective cardiac output. Because there is no cardiac output, the body is left without oxygenation. Sinus tachycardia requires treatment to slow the rate to 60 to 100 beats/minute. Atrial fibrillation requires treatment to convert the rhythm back to a normal sinus rhythm with one atrial contraction for every ventricular contraction. Normal sinus rhythm, in which the rate is 60 to 100 beats/minute, requires no treatment. p. 800

Pt. teaching warfarin & digoxin-atrial fibrillation

Vitamin K can counteract the effects of warfarin. Therefore, the patient needs to be taught which foods contain Vitamin K. Because warfarin is prescribed for patients in atrial fibrillation because of the risk for clot development in the heart resulting in stroke, heart attack, or pulmonary embolism, it should be included in the patient education. A major side effect of warfarin is bleeding. Therefore, the patient should be taught to notify the primary health care provider if he or she develops nosebleeds. p. 796

Accelerated junctional rhythm ECG

absent P wave and inverted P wave before or following QRS complex

Arterial side of vascular system regulates

blood pressure

Pt. teaching nitro

if doesn't tingle under tongue, not working. Don't expose to sunlight and check expiration date. Take 3 in 5 min intervals, if pain is not relieved, call 911

HDL normal value

men 35-70 women 35-85

Angina Pectoris- silent ischemia

myocardial damage, no symptoms

The blood pressure of a 71-year-old patient admitted with pneumonia is 160/70 mm Hg. What is an age-related change that contributes to this finding? Stenosis of the heart valves Decreased adrenergic sensitivity Increased parasympathetic activity Loss of elasticity in arterial vessels

of elasticity in arterial vessels An age-related change that increases the risk of systolic hypertension is a loss of elasticity in the arterial walls. Because of the increasing resistance to flow, pressure is increased within the blood vessel and hypertension results. Valvular rigidity of aging causes murmurs and decreased adrenergic sensitivity slows the heart rate. Blood pressure is not raised. Increased parasympathetic activity would slow the heart rate. p. 691

Hyperkalemia ECG

peaked T wave

digoxin

positive inotrope increases contractility HF pt's need to have levels measured on reg basis to avoid toxicity