Unit 2- Med Surg: Cardiovascular

A nurse is orientating a newly licensed nurse on the care of a cleint who is to have a line placed for hemodynamic monitoring. Which of the following statements by the newly licensed nurse indicates understanding?

"A chest x-ray is needed to verify placement after the procedure."

A nurse is caring for a client who asks why the provider prescribed a daily aspirin. Which of the following responses should the nurse make?

"Aspirin reduces the formation of blood clots that could cause heart attack.:

After receiving nitroglycerin, a client says his chest pain has diminished. The physician orders transdermal nitroglycerin, 0.2-mg/hour patch, as prophylaxis for angina pectoris. When teaching the client how to apply the transdermal system, which instruction should the nurse provide?

"Be sure to report skin irritation or other adverse reactions."

A client with known coronary artery disease reports intermittent chest pain, usually on exertion. The physician diagnoses angina pectoris and orders sublingual nitroglycerin to treat acute angina episodes. When teaching the client about nitroglycerin administration, which instruction should the nurse provide?

"Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up."

The nurse is reviewing discharge instructions with a patient who underwent a left groin cardiac catheterization 8 hours ago. Which of the following instructions should the nurse include?

"Do not bend at the waist, strain, or lift heavy objects for the next 24 hours"

A nurse is teaching a client who has polycythemia vera about self-care measures. Which of the following interventions should the nurse include?

"Elevate your legs when sitting."

You are doing an admission assessment on a client who is having outpatient testing done for cardiac problems. What should you ask this client during your assessment?

"Have you had any episodes of dizziness or fainting?

Which statement would lead the nurse to determine that a client lacks understanding of her acute cardiac illness and the ability to make changes in her lifestyle?

"I already have my airline ticket, so I will not miss my meeting tomorrow."

A nurse is completing dietary teaching with a client who has heart failure and is prescribed a 2 g sodium diet. Which of the following statements by the client indicates an understanding of the teaching?

"I can have yogurt as a dessert."

A nurse is providing teaching for a client who has a prescription for a low-sodium diet to manage hypertension. Which of the following statement by the client indicates an understanding of the teaching?

"I can snack on fresh fruit."

The nurse has just completed discharge teaching for a client recently diagnosed with hypertension. Which of the following statements by the client indicate understanding of the Dietary Approaches to Stop Hypertension (DASH) diet? Select all that apply.

"I need to eat less red meat and more fresh vegetables." "I'll limit drinking soda to only one at a time as an occasional treat." "I'm going to replace potato chips with fruit during meals and snacking."

A nurse is providing discharge teaching to a client who has a new permanent pacemaker. Which of the following statements by the client indicates an understanding of the teaching?

"I should check my heart rate at the same time each day."

A nurse is teaching a client with heart disease about a low-cholesterol diet. Which of the following statements indicates the teaching was effective?

"I should remove the skin from poultry before eating it."

The nurse teaches a client at risk for coronary artery disease about lifestyle changes needed to reduce his risks. The nurse determines that the client understands these necessary lifestyle changes if the client makes which statements? Select all that apply.

"I will be sure to include some exercise such as walking in my daily activities." "I will work at losing some weight so that my weight is at normal range for my age." "I will limit my sodium intake every day and avoid eating high-sodium foods such as hot dogs." "I will schedule regular doctor appointments for physical examinations and monitoring my blood pressure."

A nurse is teaching a client who has angina about a new prescription for metoprolol. Which of the following statments by the client indicates understanding of the teaching?

"I will call my doctor if my pulse rate is less than 60."

A nurse is providing information to a client who is scheduled for an exercise electrocardiography test. Which of the following client statements indicates an understanding of the teaching?

"I will not drink coffee 4 hr prior to my test."

A nurse is providing teaching to an adult female client who has infective endocarditis about how to prevent recurrences. Which of the following statements by the client indicates an understanding of the teaching?

"I will notify my doctor before I have dental procedures."

A client is participating in a cardiac research study in which his physician is directly involved. Which statement by the client indicates a need for additional teaching about his rights as a research study participant?

"I'll have to find a new physician if I don't complete this study."

A client is scheduled for insertion of a coronary stent with right groin access. Which teaching points should the nurse include in this client's preoperative teaching plan? Select all that apply

"If you have chest pain during this procedure, please tell the staff when or if this should occur." "You will need to remain flat during the procedure and for 3 to 6 hours after the procedure"

What instructions to the nurse give the client who will be starting a prescription for simvastatin 40 mg/day client? Select all that apply.

"If you miss a dose, take it when you remember." "Report muscle pain or tenderness to your health care provider." "Continue to follow a diet that is low in saturated fats."

A client recovering from a myocardial infarction asks why he needs to take a stool softener. He says, "I had a heart attack; I don't have a problem with constipation." Which explanation should the nurse use to answer the client's question?

"If you strain to have a bowel movement, you can cause a drop in your heart rate that can be dangerous."

A nurse is teaching a 70-year-old client about risk factors for heart failure. The client has mild asthma, diabetes mellitus, coronary artery disease. Which of the following statement by the client indicates an understanding of teaching?

"My coronary artery disease is a risk factor for heart failure."

The nurse is caring for a client anticipating further testing related to cardiac blood flow. Which statement, made by the client, would lead the nurse to provide additional teaching?

"My niece thought that I would be ordered a magnetic resonance imaging even though I have a pacemaker."

A nurse is providing discharge teaching to a client who had sickle cell crisis. Which of the following statements indicates that the client understand this instructions?

"Physical activity is good for me, but I need to avoid overexertion."

How should the nurse instruct the client with unstable angina to use sublingual nitroglycerin tablets when chest pain occurs?

"Sit down and then take one tablet if pain persists after 5 minutes call 911"

The nurse is teaching a client who has had a myocardial infarction about using nitroglycerin spray. Which information should the nurse include in the teaching plan? Select all that apply

"Spray the medication under the tongue as soon as you have chest pain." "If the chest pain continues after 2 sprays of the medication, wait 5 minutes and use 1 more spray." "Call 911 if chest pain continues after 10 minutes of using the 3 spray."

When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris?

"The pain occurred while I was mowing the lawn."

The nurse in a cardiac clinic is taking vital signs of a 58-year-old man who is 3 months status post myocardial infarction (MI). While the physician is seeing the client, the client's spouse approaches the nurse and asks about sexual activity. "We are too afraid he will have another heart attack, so we just don't have sex anymore." The nurse's best response is which of the following?

"The physiologic demands are greatest during orgasm and are equivalent to walking 3 to 4 miles per hour on a treadmill."

A client hospitalized with a myocardial infarction (MI) has a blood glucose levels ranging from 12-28 mmol/L (216-504 mg/dL) asks the nurse why the readings are so high even though there are no added sweets on the diet tray. What is the best response by the nurse?

"The stress level in your body has increased with the MI, and more glucose is released during stressful times."

A client with chronic heart failure has atrial fibrillation and mistaken warfarin what should the nurse tell the client about the expected outcome of this drug?

"This medication will prevent a clot from forming."

A client who just learned that he has a variant (Prinzmetal's) angina asks the nurse how this type of angina compares with stable angina. Which of the following replies should the nurse make?

"Variant angina can cause changes on your electrocardiogram."

A nurse is teaching a client who is scheduled for coronary angiography. Which of the following statements should the nurse include?

"You will need to keep you affect leg starting following the procedure."

A nurse is caring for a client who is in hypovolemic shock. While waiting for a unit of blood, the nurse should administer which of the following IV solutions?

0.9% Sodium chloride

A nurse is assessing a client with heart failure. The nurse should assess the client based on which compensatory mechanisms that are activated in the presence of heart failure? Select all that apply. 1. Ventricular hypertrophy. 2. Parasympathetic nervous stimulation. 3. Renin-angiotensin-aldosterone system. 4. Jugular venous distention. 5. Sympathetic nervous stimulation

1. Ventricular hypertrophy. 3. Renin-angiotensin-aldosterone system. 5. Sympathetic nervous stimulation

A nurse is preparing to transfuse 250 mL packed red blood cells (RBCs) to a client over 4 hr. A blood administration set is available that delivers 10 gtt/mL. The nurse should set the manual blood transfusion to deliver how many gtt/min. (Fill in the black with the numeric value only, round to the answer to the nearest whole number, and use a leading zero if applicable. Do not use a trailing zero.)

10

A client with hypertensive emergency is being treated with sodium nitroprusside. In a dilution of 50mg/250mL, how many micrograms of sodium nitroprusside are in each milliliter? Round your answer to a whole number.

200 mcg

A client receiving an IV infusion of heparin sodium at 1,200 units/h. The dilution is 25,000 unites/500mL. How many milliliters per house will this client receive? Round your answer to a whole number

24 mL/hr

The nurse notices that a client's heart rate decreases from 63 to 50 beats per minute on the monitor. The nurse should first 1. Administer Atropine 0.5 mg I.V. push 2. Auscultate for abnormal heart sounds .3. Prepare for transcutaneous pacing. 4. Take the client's blood pressure.

4. Take the client's blood pressure.

Furosemide 40 mg intravenous push is prescribed. Furosemide 10 mg/mL is available how much should the nurse administer round your answer to a whole number

4m:

Furosemide is administered intravenously to a client with heart failure. How soon after administration should the nurse begin to see evidence of the drugs desired effect?

5 to 10 minutes

The nurse is assessing clients at a health fair. Which client is at greatest risk for coronary artery disease?

A 65-year-old female who is obese with an LDL of 188.

Which symptom should the nurse teach the client with unstable angina to report immediately to the health care provider?

A change in the pattern of chest pain

Which of the following symptoms should the nurse teach the client with unstable angina to report immediately to her physician?

A change in the pattern of her pain.

A nurse on a cardiac unit is caring for a group of clients. The nurse should recognize which of the following clients as being at risk for the development of a dysrhythmia? (Select all that apply.)

A client who has metabolic alkalosis A client who has COPD

A nurse in a provider's office is reviewing the medical records of a group of clients. Which of the following client is at risk for an iron deficiency? Select all that apply

A client who is a vegetarian A client who is pregnant A toddler who is over weight

The nurse is assessing a patient who complains of feeling "light-headed." When obtaining orthostatic vital signs, what does the nurse determine is a significant finding?

A heart rate of more than 20 bpm above the resting rate

A client arrives in the emergency department complaining of chest pain that began 4 hours ago. A troponin T blood specimen is obtained, and the results indicate a level of 0.6 ng/mL. The nurse determines that this result indicates which finding?

A level that indicates a myocardial infarction

A nurse is rewarming a client following coronary artery bypass graft (CABG) surgery. For which of the following complications of the rewarming process should the nurse monitor the client?

Acidosis

A nurse is assessing a client who is 85 years old. Which of the following findings should the nurse identify as a manifestation of myocardial infarction?

Acute confusion

A nurse is caring for a client who has an abdominal aortic aneurysm and is scheduled for surgery. The client's vital signs are blood pressure 160/98 mmHg, heart rate 102/min, respirations 22/min, and SpO2 95%. Which of the following actions should the nurse take?

Administer antihypertensive medication for blood pressure

A client admitted for a myocardial infarction (MI) develops cardiogenic shock. An arterial lines is inserted. Which prescription from the healthcare provider should the nurse verify before implementing?

Administer metoprolol 5 mg IV push

A client is scheduled for an elective electrical cardioversion for a sustained dysrhythmia lasting 24 hours. Which intervention is necessary for the nurse to implement prior to the procedure?

Administer moderate sedation via IV and analgesic medication as prescribed

A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What is the nurse's priority action

Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin

An adult comes to the emergency department with crushing substernal chest pain that radiates to the shoulder and left arm. The admitting diagnosis is acute myocardial infarction. Prescriptions include oxygen by nasal cannula at 4L/min, complete blood count, a chest radiography, a 12-lead electrocardiogram (ECG), and 2 mg of morphine sulfate give IV. What should the nurse do first?

Administer the morphine

A 60-year-old male client comes into the emergency department with a complaint of crushing substernal chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial infarction (MI). Immediate admission orders include oxygen by nasal cannula at 4 L/minute, blood work, a chest radiograph, a 12-lead electrocardiogram (ECG), and 2 mg of morphine sulfate given

Administer the morphine.

The nurse is getting ready to defibrillate a client who is in ventricular fibrillation (see photo). What should the nurse do?

After pressing charge and calling "all clear," deliever the shock

A nurse is admitting a client who is in sickle cell crisis. Besides pain management, which of the following interventions should the nurse include in the client's plan of care?

Ample hydration

The nurse is assessing the client diagnosed with congestive heart failure. Which laboratory data would indicate that the client is in severe congestive heart failure?

An elevated B-type natriuretic peptide (BNP).

Clients with heart failure are prone to atrial fibrillation. During physical assessment, the nurse should suspect atrial fibrillation when palpation of the radial pulse reveals:

An irregular pulse rhythm.

The nurse is performing a physical assessment on a client. The nurse is concerned that client might have atrial fibrillation. The nurse is going to palpate the radial pulse, which sign would indicate atrial fibrilation?

An irregular rhythm with a varying pulse rate

A nurse is assessing a client who has peripheral vascular disease and a venous ulcer on the right ankle. Which of the following findings should the nurse expect in the client's affected extremity?

Ankle swelling

A client presents to the ER with complaints of syncope, shortness of breath, and palpations. The nurse places the client on ECG (see photo). What should the nurse do? Select all that apply.

Apply oxygen Monitor vital signs Educate the client on the potential cardioversion as medical treatment

The nurse is preparing to defibrillate a patient in ventricular fibrillation. Place the following steps in the order the nurse should complete them. All options must be used.

Apply the multifunction conductor pads to the client's chest Turn on the defibrillator and place it in "not sync" mode Charge the defibrillator to the prescribed voltage Call "CLEAR" three times ensuring client and environmental safety Deliver the prescribed electrical charge

A nurse is caring for a client who has an upper gastrointestinal bleed and a hematocrit of 24%. Prior to initiating a transfusions of packed red blood cells (RBCs), which of the following actions should the nurse take? Select all that apply.

Assess and document the client's vital signs Verify with another nurse the blood type and Rh of the packed RBCs Change IV tubing to a set that has a filter

The nurse is caring for a client diagnosed with an anterior myocardial infarction 2 days ago. Upon assessment, the nurse identifies a systolic murmur at the apex. What should the nurse do first?

Assess for changes in vital signs

The nurse is caring for a client diagnosed with an anterior myocardial infarction 2 days ago. Upon assessment, the nurse identifies a new systolic murmur at the apex. The nurse should first:

Assess for changes in vital signs.

The nurse is admitting an older adult to the hospital. The echocardiogram report revealed left ventricular enlargement. The nurse notes 2+ pitting edema in the ankles when getting the client into bed based on this finding, what should the nurse do first?

Assess respiratory status

The nurse is admitting a 68-year-old male to the medical floor. The echocardiogram report revealed left ventricular enlargement. The nurse notes 2+ pitting edema in the ankles when getting the client into bed. Based on this finding, what should the nurse do first?

Assess respiratory status.

The nurse is caring for a client on a monitored telemetry unit. During morning assessment, the nurse notes abnormal ECG waves on the telemetry monitor. Which action would the nurse do first?

Assess the client

The nurse is assessing a client who has had a myocardial infarction (MI). The nurse notes that cardiac rhythm on the monitor (see the electrocardiogram strip). What should the nurse do first?

Assess the client for changes in the rhythm

The client is scheduled for a right femoral cardiac catheterization. Which nursing intervention should the nurse implement after the procedure?

Assess the client's neurovascular status.

A nurse is preparing a client for cardiac catheterization. The nurse must provide which nursing intervention immediately when the client returns to his room after the procedure?

Assess the puncture site frequently for hematoma formation or bleeding

The nurse is caring for a client who, 30 minutes ago, underwent an ablation procedure for supraventricular tachycardia in the cardiac catheterization laboratory. The client has a dressing over the femoral insertion site with a small amount of oozing blood. Which action by the nurse causes the charge nurse to intervene?

Assists client to sit on the side of the bed to use the urinal

Which condition most commonly results in coronary artery disease (CAD)?

Atherosclerosis

A nurse is planning care for a client who has acute myelogenous leukemia and a platelet count of 48,000/mm3. Which of the following interventions should the nurse include?

Avoid IM injections

A patient has undergone a cardiac catheterization. He is to be discharged today. What information should the nurse emphasize during discharge teaching?

Avoid heavy lifting for the next 24 hours.

The nurse is providing discharge education for the client going home after a cardiac catheterization. Which of the following would be important information to give this client?

Avoid tub baths, but shower as desired.

The nurses teaching a client with heart failure how to avoid complications in further hospitalizations. The client has understood the instruction when the client identifies which potential complications? Select all that apply

Becoming increasingly short of breath at rest Weight gain of 2lbs (0.9 kg) or more in 1 day Having to sleep sitting up in the reclining chair

A nurse is teaching a client who has iron-deficiency anemia. The nurse should encourage the client to increase consumption of which of the following foods?

Beef liver

A nurse is assessing a client who is undergoing hemodynamic monitoring. The client has a CVP of 7 mm Hg and a PAWP of 17 mm Hg. Which of the following findings should the nurse expect? (Select all that apply)

Bilateral crackles in the lungs JVD

A cardiac catheterization was performed on a client 2 hours ago. The catheter was inserted into the left femoral artery. What signs of potential complications should the nurse report immediately to the health care provider (HCP)? Select all that apply.

Bleeding at the catheterization site Left foot remarkably cooler than right foot

A nurse is assessing for disseminated intravascular coagulation (DIC) in a client who has septic shock secondary to an untreated foot wound. Which of the following findings should the nurse expect? (Select all that apply)

Bleeding at the venipuncture site Petechiae on the chest and arms Abdominal distension

A pulmonary artery catheter is inserted in a client with severe mitral stenosis and regurgitation. The nursing administers furosemide and nitroprusside as prescribed. The nurse notices they sit and drop in the pulmonary artery systolic pressure in pulmonary artery wedge pressure. What should the nurse assess next?

Blood pressure

An older client with a history of heart failure is admitted to the emergency department with pulmonary edema. During admission, what should the nurse assess first?

Blood pressure

A client with chest pain is prescribed intravenous nitroglycerin. Which assessment is of greatest concern for the nurse initiating the nitroglycerin drip?

Blood pressure is 88/46 mm Hg.

A client with chest pain is prescribed intravenous nitroglycerin (Tridil). Which assessment is of greatest concern for the nurse initiating the nitro-glycerin drip?

Blood pressure is 88/46.

A 69-year-old female has a history of heart failure. She is admitted to the emergency department with heart failure complicated by pulmonary edema. On admission of this client, which of the following should the nurse assess first?

Blood pressure.

Good dental care is an important measure in reducing the risk of endocarditis. What information about dental care should the nurse include in the teaching plan for a client with mitral stenosis? Select all that apply.

Brush their teeth at least twice a day Floss the teeth at least once daily Have regular dental checkups

Which of the following is an expected out-come for a client on the second day of hospitalization after a myocardial infarction (MI)? The client:

Can perform personal self-care activities with-out pain

Which food should the nurse teach a client with heart failure to limit when following a 2-g sodium diet?

Canned tomato juice

which food should the nurse teach a client with heart failure to limit when following a 2 gram sodium diet?

Canned tomato juice whole wheat bread hamburger

When monitoring client who is receiving tissue plasminogen activator (t-PA), the nurse should assess the client for which changes?

Cardiac arrhythmia a middle-aged client with a history of hypertension reports having indigestion

When monitoring a client who is receiving tissue plasminogen activator (t-PA), the nurse should have resuscitation equipment available because reperfusion of the cardiac tissue can result in which of the following?

Cardiac arrhythmias.

A nurse is caring for a client who reports calf pain. What is the first action the nurse should take?

Check the affected extremity for warmth and redness

A nurse is preparing to administer packed RBCs to a client who is anemic. Which of the following actions should the nurse take? Select all that apply

Check to determine the packed RBCs are less than 1 week old Ask another nurse to check the packed RBC's label against the medical record Prime the transfusion tubing with 0.9% sodium chloride

A cardiac catheterization, using the femoral artery approach, is performed to assess the degree of coronary artery thrombosis in a client. Which priority safety actions should the nurse implement in the post procedure period? Select all that apply.

Checking the client's groin for bleeding Encouraging the client to increase fluid intake Instructing the client to move the toes when checking circulation, motion, and sensation

A nurse is completing an assessment for a client who has a history of unstable angina. Which of the following findings should the nurse expect?

Chest pain lasts for longer than 15 mins.

The nurse is taking a health history from a client admitted with the medical diagnosis of cardiovascular disease (CVD). Identify which of the following symptoms indicate CVD

Chest pain, weight gain, fatigue

A 65-year-old client is admitted to the emergency department with a fractured hip. The client has chest pain and shortness of breath. The health care provider orders nitroglycerin tablets. Which should the nurse instruct the client to do?

Chew the tablet until it is dissolved.

A nurse is teaching about a low-cholesterol diet to a client who had myocardial infarction. Which of the following meal selections by the client indicates an understanding of the teaching?

Chicken breast and corn on the cob

A nurse at a provider's office is reviewing the laboratory results for a group of clients. The nurse should identify that which of the following results indicates the client as risk for heart disease? Select all that apply)

Cholesterol (total) 245 mg/dL LDL 140 mg/dL

The nurse is preparing to apply ECG electrodes to a male patient who requires continuous cardiac monitoring. Which of the following should the nurse complete to optimize skin adherence and conduction of the heart's electrical current?

Clip the patient's chest hair prior to applying the electrodes

The nurse has completed an assessment on a client with a decreased cardiac output. Which findings should receive the highest priority?

Confusion, urine output 15 mL over the last 2 hours, orthopnea.

A nurse assessing a client who underwent cardiac catheterization finds the client lying flat on the bed. His temperature is 99.8° F (37.7° C). His blood pressure is 104/68 mm Hg. His pulse rate is 76 beats/minute. The nurse assesses the limb and detects weak pulses in the leg distal to the puncture site. Skin on the leg is cool to the touch. The puncture site is dry, but swollen. What is the most appropriate action for the nurse to take?

Contact the physician and report the findings.

A nurse is caring for a client with type 2 diabetes who has had a myocardial infarction (MI) and is reporting nausea, vomiting, dyspnea, and substernal chest pain. Which of the following is the priority intervention?

Control the pain and support breathing and oxygenation

The nurse is assessing a client with a known history for chronic heart failure. Which finding indicates poor perfusion to the tissue?

Cool, pale extremities

The client has been managing angina episodes with nitroglycerin. Which finding indicates that the therapeutic effect of the drug has been achieved?

Decrease chest pain

Metoprolol is added to the pharmacological therapy of a diabetic female diagnosed with stage two hypertension who has been initially treated with furosemide in ramipril. The nurse should evaluate the client for which expected therapeutic effect?

Decrease in heart rate

A nurse is reviewing the laboratory findings of a client who has protein-calorie malnutrition. Which of the following findings should the nurse expect?

Decreased albumin

Which of the following would be an indication for a transesophageal echocardiography (TEE)?

Determination of atrial thrombi

When preparing a client for a cardiac angiogram, what action should the nurse take? Select all that apply

Determine if the client has an allergy to liquid contrast material Inform he client that an intravenous infusion will be started before the procedure Remind the client to have nothing to eat or drink 8 hours before the procedure Instruct the client to remain still during the procedure

The health care provider documents that the patient's pulse quality is a +1 on a scale of 0 to 4. The nurse knows that this describes a pulse that is:

Difficult to palpate and is obliterated with pressure

A client with heart failure is taking furosemide, digoxin, and potassium chloride. The client has nausea, blurred vision, headache, and weakness. The nurse notes that the client is confused. The telemetry strip shows first degree atrioventricular block. What other sign should the nurse assess next?

Digoxin toxicity

A client has a history of heart failure and has been taking several medications, including furosemide (Lasix), digoxin (Lanoxin) and potassium chloride. The client has nausea, blurred vision, headache, and weakness. The nurse notes that the client is confused. The telemetry strip shows first-degree atrioventricular block. The nurse should assess the client for signs of which condition?

Digoxin toxicity.

The nurse is caring for a patient in the ICU diagnosed with coronary artery disease (CAD). Which of the following assessment data indicates the patient is experiencing a decrease in cardiac output?

Disorientation, 20 mL of urine over the last 2 hours

When administering a thrombolytic drug to the client who is experiencing a myocardial infarction (MI) and who has premature ventricular contractions, which is the expected outcome of the drug?

Dissolve clots

When administering a thrombolytic drug to the client experiencing a myocardial infarction (MI), the nurse explains that the purpose of the drug is to:

Dissolve clots that he may have.

The nurse is assessing a client who has had a stent inserted in a coronary artery via the right femoral artery. The client is receiving intravenous heparin sodium at 1,000 units per house. During the second post procedure check, the nurse notes that the puncture site at the groin has begun to steadily ooze blood. What should the nurse do first?

Don gloves and apply direct pressure over the site

A client returns from a left heart catheterization. The right groin was used for catheter access. In which location should the nurse palpate the distal pulse on this client?

Dorsal surface of the right foot

A client is taking clonidine for treatment of hypertensive. The nurse should teach the client about which common adverse effects of this drug? Select all that apply:

Dry mouth Impotence Sleep disturbance

A nurse is preparing an in-service presentation about the management of myocardial infarction (MI). Death following MI is often a result of which of the following complications?

Dysrhythmias

A client comes to the emergency department complaining of chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see?

Elevated ST segment

The nurse is reviewing the assessment data of a client. Which finding is most important for the client to modify to lessen the risk for coronary artery disease (CAD)?

Elevated low-density lipoprotein (LDL) levels

You are monitoring the results of laboratory tests performed on a client admitted to the cardiac ICU with a diagnosis of myocardial infarction. Which test would you expect to show elevated levels?

Enzymes

A nurse is caring for a client who has severely elevated blood pressure. Which of the following findings should the nurse identify as a manifestation of hypertension?

Epistaxis

A nurse is reviewing the laboratory results of a client who has end-stage renal disease and reports fatigue. The client's hemoglobin level is 8 g/dL. The nurse should expect a prescription for which of the following medicaitons?

Erythropoietin

An older adult takes two 81-mg aspirin tablets daily to prevent a heart attack. The client reports having a constant "ringing" in both ears. How should the nurse respond to the client's comment?

Explain to the client that the "ringing" may be related to the aspirin.

The nurse prepares to auscultate heart sounds. Which nursing interventions would be most effective to assist with this procedure?

Explain to the client that the nurse will be listening to different areas of the chest and may listen for a long time, but that does not mean that anything abnormal is heard.

A nurse is caring for a client who experienced defibrillation. Which of the following should be included int he documentation of this procedure? (Select all that apply)

Follow up ECG Energy settings used Skin condition under electrode

A harsh grating sound caused by abrasion of the pericardial surfaces during the cardiac cycle is termed which of the following?

Friction rub

A client who has been experiencing angina has a new prescription for nitroglycerin. The nurse should instruct the client to report having which potential side effect of nitroglycerin?

Headache

The nurse is reviewing the results of the patient's echocardiogram and observes that the ejection fraction is 35%. The nurse anticipates that the patient will receive treatment for what condition?

Heart failure

The client has risk factors for coronary artery disease, including smoking cigarettes, eating a diet high in saturated fat, and leading a sedentary lifestyle. Which coaching strategies from the nurse will be most effective in assisting the client improve his or her health?

Helping the client establish a wellness vision to reduce the health risks

A nurse is reviewing laboratory values for a client diagnosed with hyperlipidemia 6 months ago. Which results indicate that the client has been following his therapeutic regimen?

High density lipoproteins (HDL) increase from 25 mg/dl to 40 mg/dl.

Contraindications to the administration of tissue plasminogen activator (t-PA) include which of the following?

History of cerebral hemorrhage.

The client is scheduled to have a cardiac catheterization. Which findings will cause the nurse to question the safety of the test proceeding? Select all that apply.

History of previous reaction to IV contrast Serum creatinine of 2.5 mg/dL (221 µmol/L) Took metformin today for type 2 diabetes

A nurse is caring for a client who has emphysema and chronic respiratory acidosis. The nurse should monitor the client for which of the following electrolyte imbalances?

Hyperkalemia

A nurse is providing teaching for a client who has anemia and a new prescription for epoetin alfa. Which of the following pieces of information should the nurse include in the teaching?

Hypertension is a common adverse effect of this medication

A nurse is caring for a client who has peripheral vascular disease (PVD) and ulcers on the toes. Which of the following findings of PVD is a risk factor for ulceration of the extremeties?

Impaired circulation

The nurse reviews a patient's lab results and notes a serum calcium level of 7.9 mg/dL. The nurse knows that this reading can also be associated with which of the following?

Impaired myocardial contractility

What is the major goal of nursing care for a client with heart failure in pulmonary edema?

Increase cardiac output

The major goal of therapy for a client with heart failure and pulmonary edema should be to:

Increase cardiac output.

A nurse is assessing a client who has isotonic dehydration. Which of the following findings should the nurse expect?

Increase hematocrit level

A client with heart failure is receiving digoxin intravenously. The nurse should determine the effectiveness of the drug by assessing which of the following?

Increased myocardial contractility.

Age-related changes associated with the cardiac system include which of the following? Select all that apply.

Increased size of the left atrium Endocardial fibrosis

Which is an expected outcome when a client is receiving an IV administration of furosemide?

Increased urine output

A nurse is planning care for a client who has pernicious anemia. Which of the following interventions should the nurse include in the plan?

Initiate weekly injection so vitamin B12

A 68-year-old female client on day 2 after hip surgery has no cardiac history but reports having chest heaviness. The first nursing action should be to:

Inquire about the onset, duration, severity, and precipitating factors of the heaviness.

A client with angina is taking nifedipine. Which instruction should the nurse give the client?

Inspect gums daily

A client with angina has been taking nifedipine. The nurse should teach the client to:

Inspect gums daily.

A client experiences orthostatic hypotension while receiving furosemide to treat hypertension. How should the nurse intervene?

Instruct the client to sit for several minutes before standing.

What information should the nurse provide to the client who is receiving warfarin?

Internationalized normalized ratio (INR) is used to assess effectiveness

A nurse is caring for a client following a stroke. Which of the following actions should the nurse take first?

Keep the client NPO

Which of the following is not a risk factor for the development of atherosclerosis?

Late onset of puberty.

The nurse is performing an assessment of the patient's heart. Where would the nurse locate the apical pulse if the heart is in a normal position?

Left 5th intercostal space at the midclavicular line

A nurse is teaching a client who has iron-deficiency anemia. The nurse should encourage the client to increase her consumption of which of the following foods?

Lentils

A nurse is preparing to assess a patient for postural BP changes. Which of the following indicates the need for further education?

Letting 30 seconds elapse after each position change before measuring BP and heart rate (HR)

The nurse is preparing the client for discharge after mitral valve replacement surgery. Which activity should the client avoid until after the one month post discharge appointment with the surgeon?

Lifting anything heavier than 10 lb (4.5 kg)

The nurse is providing care for a patient with high cholesterol and triglyceride values. In teaching the patient about therapeutic lifestyle changes such as diet and exercise, the nurse realizes that the desired goal for cholesterol levels is which of the following?

Low LDL values and high HDL values

A nurse is assessing a client who is receiving a unity of whole blood. Which of the following findings should the nurse identify as a manifestation of a hemolytic transfusion reaction?

Low back pain

The nurse should be especially alert for signs and symptoms of digoxin toxicity if serum levels indicate that the client has a:

Low potassium level.

The nurse is caring for a patient recovering from a coronary angioplasty with stent placement. Which intervention is a priority for the patient at this time?

Maintaining leg extension on the affected side

A nurse is planning care for a client who has thrombocytopenia. Which of the following interventions should the nurse include int he plan of care?

Measure the client's abdominal girth daily

A nurse is reviewing the medical of a client who is to undergo a scheduled electrical cardioversion. For which of the following findings should the nurse notify the provider? (Review the data below for additional client information.) MAR Ferrous Sulfate: 200 mg PO 0800 and 2000 Diazepam: 2 mg PO 0800 and 2000 Isosorbide: 2.5 mg PO 4 times a day AC and HS VITAL SIGNS 0800 T 99 F (37.2 C) Blood pressure: 142/86 mm Hg HISTORY AND PHYSICAL Bariatric surgery 10 years ago Dyspnea with exertion for 3 years Atrial fibrillation began 3 years ago Client reports taking the following medications for the past 6 weeks: iron supplement, multivitamin, antilipemic, and nitroglycerin

Medication history

A client has mitral stenosis and will have a valve replacement period the nurse is instructing the client about help maintenance prior to surgery. Inability to follow these prescriptions would pose the greatest health hazard to this client at this time?

Medication therapy

A nurse is planning care for a client who is having a percutaneous transluminal coronary angioplasty (PTCA) with stent placement. Which of the following actions should the nurse anticipate in the post-procedure plan of care?

Monitor for bleeding

The nurse receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following?

Myocardial damage.

An older adult had a myocardial infarction (MI) 4 days ago. At 0930, the client's blood pressure is 102/64 mm Hg. After reviewing the client's progress notes (see chart), what should the nurse do first?

Notify the health care provider (HCP)

When caring for a client who has sustained a myocardial infarction (MI), the nurse notes 8 premature ventricular contractions (PVCs) in one minute on the cardiac monitor. The client is receiving an IV infusion of 5% dextrose in water (D5W) at 125 mL/h in oxygen at 2L/min. What should the nurse do first?

Notify the health care provider (PCP)

The intensive care department nurse is assessing the client who is 12 hours post-myocardial infarction. The nurse assesses an S3 heart sound. Which intervention should the nurse implement?

Notify the health-care provider immediately.

After the administration of t-PA, the assessment priority is to:

Observe the client for chest pain.

which is the most important initial post procedure nursing assessment for a client who has had a cardiac catheterization?

Observe the puncture site for swelling and bleeding.

The nurse is caring for a patient with clubbing of the fingers and toes. The nurse should complete which of the following actions given these findings?

Obtain an oxygen saturation level

The physician orders continuous I.V. nitro-glycerin infusion for the client with myocardial infarction. Essential nursing actions include which of the following?

Obtaining an infusion pump for the medication.

What instructions should the nurse's discharge teaching plan for the client with heart failure include?

Obtaining daily weights at the same time each day

A nurse is completing a medication history for a client who reports using fish oil as a dietary supplement. Which of the following substances in fish oil should the nurse recognize as a health benefit in the client?

Omega-3 fatty acids

The nurse is providing discharge instructions to a client with unstable angina. The client is ordered Nitrostat 1/150 every 5 minutes as needed for angina. Which side effect, emphasized by the nurse, is common especially with the increased dosage?

Orthostatic hypotension

A client is scheduled to undergo percutaneous transluminal coronary angioplasty (PTCA). Which statement by the nurse best explains the procedure to the client?

PTCA involves opening a blocked artery with an inflatable balloon located on the end of a catheter

A nurse on a cardiac unit is caring for a client who is on telemetry. The nurse recognizes the client's heart rate is 46/min and notifies the provider. Which of the following prescriptions might be appropriate for this client?

Pacemaker insertion

A nurse is checking paradoxical blood pressure of a client who has possible cardiac tamponade. In which order should the nurse completed the following steps? (Move the steps into the box on the right, placing them in the order of performance. Us all the steps.)

Palpate the blood pressure and inflate the cuff above the systolic pressure. Deflate the cuff slowly and listen for the first audible sounds. Identify the first BP sounds audible on expiration and then on inspiration Subtract the inspiratory pressure from the expiratory pressure Inspect for jugular venous distention and notify the provider

The client is admitted to the telemetry unit due to chest pain. The client has polysubstance abuse. and the nurse assesses that the client is anxious and irritable and has moist skin. What should the nurse do in order of priority from first to last? All options are used

Position electrodes on the chest Take vital signs Administer the prescribed dose of morphine Obtain a history of which drugs the client has used recently

Which of the following laboratory results should the nurse anticipate as the cause of this ECG change?

Potassium 2.8 mEq/L

After a myocardial infarction, the hospitalized client is taught to move the legs while resting in bed. What is the expected outcome of this exercise?

Prevent throbophlebitis and blood cloth formation

A client with chronic heart failure has atrial fibrillation and a left ventricular ejection fraction of 15%. The client is taking warfarin (Coumadin). The expected outcome of this drug is to:

Prevent thrombus formation

Acetylsalicylic acid (aspirin) is prescribed for a client diagnosed with coronary artery disease before a percutaneous transluminal coronary angioplasty (PTCA). The nurse administers the medication understanding that it is prescribed for what purpose?

Prevent thrombus formation

A nurse is monitoring the electrocardiogram of a client who has hypocalcemia. Which of the findings should the nurse expect?

Prolonged QT intervals

A nurse is reviewing a client's repeat laboratory result 4 hr after administering fresh frozen plasma (FFP). Which of the following laboratory results should the nurse review?

Prothrombin time

Which of the follow arteries carries deoxygenated blood?

Pulmonary artery

The nurse is assessing a patient's blood pressure. What does the nurse document as the difference between the systolic and the diastolic pressure?

Pulse pressure

An older adult has chest pain and shortness of breath. The healthcare provider (HCP) prescribes nitroglycerin tablets. What should the nurse instruct the client to do?

Put the tablet under the tongue until it is all absorbed

You are the clinic nurse doing assessments on your clients before they have outpatient diagnostic testing done. What would you document when assessing the client's pulse?

Rate, quality, and rhythm

Which activity would be appropriate to delegate to unlicensed personnel for a client diagnosed with a myocardial infarction who is stable?

Record the intake and output.

A client has chest pain rated at 8 on a 10-point visual analog scale. The 12-lead electrocardiogram reveals ST elevation in the inferior leads and troponin levels are elevated. What should the nurse do first?

Reduce pain and myocardial oxygen demand.

Decreased pulse pressure reflects

Reduced stroke volume

A client with acute chest pain is receiving IV morphine sulfate. Which is an expected effect of morphine? Select all that apply.

Reduces myocardial oxygen consumption Reduces blood pressure and heart rate Reduces anxiety and fear

A nurse is transfusing a unit 0f B-positive fresh frozen plasma to a client whose blood type is 0-negative. Which of the following actions should the nurse take?

Remove the unit of plasma immediately and start an IV infusion of normal saline solution

The nurse is caring for an older adult with mild dementia admitted with heart failure. What nursing care will be helpful for this client in reducing potential confusion related to hospitalization and change in routine? Select all that apply

Reorient frequently to time, place, and situation. Arrange for familiar pictures or special items at bedside. Spend time with client, establishing a trusting relationship

The nurse is evaluating a client who received tissue plasminogen activator (t-PA) following a myocardial infarction (MI). What is the expected outcome of this drug?

Revascularize the blocked coronary artery

Alteplase recombinant, or tissue plasminogen activator (t-PA), a thrombolytic enzyme, is administered during the first 6 hours after onset of myocardial infarction (MI) to:

Revascularize the blocked coronary artery.

If a client displays risk factors for coronary artery disease, such as smoking cigarettes, eating a diet high in saturated fat, or leading a sedentary lifestyle, techniques of behavior modification may be used to help the client change the behavior. The nurse can best reinforce new adaptive behaviors by:

Rewarding the client whenever the acceptable behavior is performed.

It is important for a nurse to understand cardiac hemodynamics. For blood to flow from the right ventricle to the pulmonary artery, the following must occur:

Right ventricular pressure must be higher than pulmonary arterial pressure

The nurse is observing a patient during an exercise stress test (bicycle). Which of the following findings indicates a positive test and the need for further diagnostic testing?

ST-segment changes on the ECG

A client reports recent onset of chest pain that occurs sporadically with exertion. The client also has fatigue and mild ankle swelling, which is most pronounced at the end of the day. The nurse suspects a cardiovascular disorder. What other client complaint increases the likelihood of a cardiovascular disorder?

Shortness of breath

The nurse is assessing a client who has had a myocardial infarction. The nurse notes the cardiac rhythm showing on the electrocardiogram strip. How should the nurse interpret the rhythm strip?

Sinus tachycarida

Which position is best for client with heart failure who has orthopnea?

Sitting upright (high Fowler's position) with legs resting on the mattress.

A nurse is presenting a community education program on recommended lifestyle changes to prevent angina and myocardial infarction. Which of the following changes should the nurse recommend be made first?

Smoking cessation

Admission lab values on a patient admitted with congestive heart failure are as follows: potassium 3.4 mEq/L; sodium 148 mEq/L; calcium 9.8 mg/dL; and magnesium 1.5 mEq/L. Which lab value is abnormal?

Sodium

The client who experiences angina has been told to follow a low cholesterol diet which meal would be best?

Spaghetti with tomato sauce, salad, and coffee

A nurse is admitting a client who has a suspected myocardial infarction (MI) and a history of angina. Which of the following findings will help the nurse distinguish stable angina from an MI?

Stable angina can be relieved with rest and nitroglycerin.

The nurse connects the client to cardiac monitor, which reveals 8 premature ventricular contractions per minute. What should the nurse do next?

Start an intravenous infusion

The nurse is caring for an elderly man who walks 2 miles every morning. The nurse notes that during his morning walk, he called his daughter and stated that he thought that he was having a heart attack. Which symptom, identified by the client, is the most common and consistent with that of a heart attack (myocardial infarction)?

Sternal pain

A nurse is caring for a client who is receiving IV ampicillin and develops urticaria and dyspnea. Which of the following actions should the nurse take first?

Stop the medication infusion.

Which information about sublingual nitroglycerin tablets should the nurse include when instructing the client with angina?

Store the tablets in a tight, light-resistant container.

Which of the following terms describes the amount of blood ejected per heartbeat?

Stroke volume

A nurse is preparing an in-service about assessing clients who are having an acute myocardial infarction (MI)/ What is the most common assessment finding with an acute MI?

Substernal chest pain

Which set of postural vital signs in a client with hypertension should the nurse report to the health care provider (HCP)?

Supine 120/70, 88 bpm Sitting 102/64, 86 bpm Standing 100/60, 92 bpm

A client has a throbbing headache when nitroglycerin is taken for angina. What should the nurse instruct the client to do?

Take acetaminophen or ibuprofen

The nurse notes that a client's heart rate decreased from 63 to 50 suddenly. Which step should the nurse preform next?

Take the client's blood pressure

The nurse notices that a client's heart rate decreases from 63 to 50 bpm on the monitor. What should the nurse do first?

Take the client's blood pressure

Following the diagnosis of angina pectoris, a client reports being unable to walk up two flights of stairs without pain. What should the nurse instruct the client to do?

Taking nitroglycerin tablet before climbing the stairs

A nurse is caring for a client who has a demand pacemaker inserted with a set rate of 72/min. Which of the following findings should the nurse expect?

Telemetry monitoring showing QRS complexes occurring at a rate of 74/min with no pacing spikes.

You are evaluating the expected outcomes on a client who is recovering from a cardiac catheterization. What is an expected outcome that you would evaluate?

The client and family understands the discharge instructions

Which is an expected outcome for a client on the second day of hospitalization after a myocardial infarction?

The client can perform personal self-care activities without pain

A nurse is evaluating a client who had a myocardial infarction (MI) 7 days earlier. Which outcome indicates that the client is responding favorably to therapy?

The client demonstrates ability to tolerate more activity without chest pain

A client has returned from the cardiac catheterization laboratory after a balloon valvuloplasty or mitral stenosis. Which finding requires immediate nursing action?

The client has become more somnolent

The client diagnosed with a myocardial infarction is six (6) hours post-right femoral percutaneous transluminal coronary angioplasty (PTCA), also known as balloon surgery. Which assessment data would require immediate intervention by the nurse?

The client is complaining of numbness in the right foot.

The client has just returned from a cardiac catheterization. Which assessment data would warrant immediate intervention from the nurse?

The client refuses to keep the leg straight.

The nurse is caring for a client who recently experienced a myocardial infarction and has been started on clopidogrel. The nurse should develop a teaching plan that includes which points? Select all that apply.

The client should report unexpected bleeding or bleeding that lasts a long time. The client may bruise more easily and may experience bleeding gums Clopidogrel works by preventing platelets from sticking together and forming a clot

In preparing a client and the family for a postoperative stay in the intensive care unit (ICU) after open heart surgery, what should the nurse tell the family?

The client will receive medication to relieve pain

The patient has a heart rate of 72 bpm with a regular rhythm. Where does the nurse determine the impulse arises from?

The sinoatrial node

A nurse notices one of the clients on the unit has frequent artifact on the ECG monitor. The nurse examines the client to determine the cause. Which of the following items is unlikely to be responsible for artifact.

Tightly secured cabel connnections

A client experiences initial indications of dizziness after having an IV infusion of Iidocaine hydrochloride started. The nurse should further assess the client for which symptoms?

Tinnitus

The nurse is caring for a client post myocardial infarction (MI). Orders include strict bed rest and a clear, liquid diet. What is the nurse's best response to the client when inquiring about the purpose of the new diet?

To reduce the metabolic workload of digestion

Which cardiac enzyme would the nurse expect to elevate first in a client diagnosed with a myocardial infarction (MI)?

Troponin

The nurse reviews laboratory data for a client admitted to the emergency department with chest pain. Which serum value requires the most immediate action by the nurse?

Troponin 0.7 ng/mL (0.7 mcg/L)

a nurse on a cardiac unit is reviewing the laboratory findings of a client who has a diagnosis of myocardial infarction (MI) and reports that his dyspnea began 2 weeks ago. which of the following cardiac enzymes would confirm the infarction occurred 14 days ago?

Troponin T

A nurse is reviewing the menu selection of a client who has heart failure and anticipates discharge to home the following day. Which of the following lunch choices should the nurse identify as an indication that the client understands his dietary instructions?

Turkey on whole-wheat bread

A client was admitted with an exacerbation of heart failure breath at 0200. At 0700, which information is most important for the nurse who admitted he client to communicate during the hand-off of care report to the nurse who will next take care of the client?

Urinary output of 120mL

The nurse is monitoring a client admitted with a myocardial infarction (MI) who is at risk for cardiogenic shock. The nurse should report which changes noted from the clients chart to the healthcare provider?

Urine output

A nurse planning care for a client who has a PICC line in the right arm. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.)

Use a 10 mL syringe to flush the PICC line. Cleanse ports with alcohol for 15 seconds prior to use. Maintain a transparent dressing over the insertion site.

The healthcare provider prescribes continuous IV nitroglycerin infusion for the client with myocardial infarction. What should the nurse do to ensure safe administration of this drug?

Use an infusion pump for the medication

As an initial step in treating a client with angina, the physician prescribes nitroglycerin tab-lets, 0.3 mg given sublingually. This drug's principal effects are produced by:

Vasodilation of peripheral vasculature.

The nurse should teach the client that signs of digoxin toxicity include which of the following?

Visual disturbances such as seeing yellow spots

The nurse is caring for a client who has just returned from having a percutaneous transluminal balloon angioplasty with femoral artery access. In which order from first to last should the nurse obtain information about the client? All options must be used

Vital signs and oxygen saturation pedal pulse catheterization site color and sensation of extremity

A nurse is caring for a client who has a new diagnosis of pernicious anemia. The nurse should expect the client's provider to prescribe which of the following medications for this client?

Vitamin B12

What measures should the nurse take that will be most helpful in preventing wound infection when changing a client's dressing after coronary artery bypass surgery?

Wash hands before changing the dressing

Captopril, furosemide, and metoprolol are prescribed for a client with systolic heart failure. The client's blood pressure is 136 slash Prior to medication administration at oh 900, the nurse reviews the following lab test what should the nurse do 136/82 mm Hg, and the heart rate is 65 bpm. Prior to medication administration at 0900, the nurse reviews the following lab tests (see chart) what should the nurse do first?

Withhold the captopril

A client is about to undergo cardiac catheterization for which he signed an informed consent. As the nurse enters the room to administer sedation for the procedure, the client states, "I'm really worried about having this open heart surgery." Based on this statement, how should the nurse proceed?

Withhold the medication and notify the physician immediately.

A client with diabetes who has been maintained on metformin has been scheduled for a cardiac catheterization. The nurse should verify that the health care provider has written which prescriptions for taking the metformin before the procedure?

Withhold the metformin

A nurse is preparing to transfuse a unit of packed red blood cells (RBCs) for a client who has anemia. Wich of the following actions should the nurse take?

Witness the informed consent document

The cardiologist has scheduled a 57-year-old male client for drug-induced stress testing. To prepare the client for this test, the nurse should instruct him about which of the following?

You will receive medication via IV administration.

Which client is at greatest risk for coronary artery disease?

a 65-year-old female who is obese with an LDL of 188 (10.4 mmol/L)

Which symptom should the nurse teach the client with unstable angina to report immediately to the health care provider (HCP)?

a change in the pattern of the chest pain

A client with angina shows the nurse the nitroglycerin that the client carries in a plastic bag in a pocket. The nurse instructs the client that nitroglycerin should be kept in:

a dark container to shield from light. the refrigerator.

Three days after mitral valve replacement surgery, the client tells the nurse there is a clicking noise from the chest incision. The nurse response should reflect the understanding that the client may be experiencing:

anxiety related to altered body image

The nurse is caring for a client diagnosed with an anterior myocardial infarction 2 days ago. Upon assessment, the nurse identifies a systolic murmur at the apex. The nurse should first:

assess for changes in vital signs

The client has had a myocardial infarction, and the nurse has instructed the client to prevent Valsalva's maneuver. The nurse determines the client is following the instructions when the client:

avoids holding the breath during activity.

A client receiving a loop diuretic should be encouraged to eat which foods to prevent potassium loss? Select all that apply

banana dried fruit orange juice

An older adult with a history of heart failure is admitted to the emergency department with pulmonary edema. On admission, what should the nurse assess first?

blood pressure

The nurse has given a client a nitroglycerin tablet sublingually for angina. Which vital signs should be assessed following administration of nitroglycerin?

blood pressure

Which food should the nurse teach a client with heart failure to limit when following a 2-gram sodium diet?

canned tomato juice

A client who has undergone a mitral valve replacement has had a mediastinal chest tube inserted. The client has persistent bleeding from the sternal incision during the early postoperative. What action should the nurse take? Select all that apply

check the post operative CBC INR PTT and platelet levels confirm availability for blood products monitor the mediastinal chest tube draining

Which of the following signs and symptoms would the nurse expect in a client with angina? Select all that apply.

chest tightness chest pressure jaw pain

A client is to have a treadmill stress test. Prior to the stress test, the nurse reviews the results of the laboratory reports. The nurse should report which elevated laboratory value to the healthcare provider (HCP) prior to the stress test?

cholesterol level

The nurse has completed an assessment on a client with a decreased cardiac output. Which findings should receive the highest priority?

confusion, urine output 15 mL over the last 2 hours, orthopnea

The ability of the cardiac muscle to shorten in response to an electrical impulse is termed

contractility.

the nurse is assessing a client with chronic heart failure who is demonstrating neurohormonal compensatory mechanisms. Which are expected findings on assessment? Select all that apply

decrease cardiac output increased heart rate vasoconstriction and skin, GI tract, and kidneys fluid overload

A nurse records a client's history and discovers several risk factors for coronary artery disease (CAD). Which cardiac risk factors can the client control?

dm, htm, hypercholesterolemia

The nurse is assessing a client who has had a stent inserted in a coronary artery via the right femoral artery. The client is receiving intravenous heparin sodium at 1000 units per hour. During the second postprocedure check, the nurse notes that the puncture site at the groin has begun to steadily ooze blood. The nurse should first:

don gloves and apply direct pressure over the site....i think this is the right answer

A client whose condition remains stable after a myocardial infarction gradually increases activity. To determine whether the activity is appropriate for the client the nurse should assess the client for:

dyspnea

The nurse should assess the client with left sided heart failure for which findings? Select all that apply.

dyspnea crackles oliguria decreased oxygen saturation

Which client admitted to the emergency department should the nurse see first? A client:

experiencing a "ripping" sensation in the chest.

A physician treating a client in the cardiac care unit for atrial arrhythmia orders metoprolol, 25 mg P.O. two times per day. Metoprolol inhibits the action of sympathomimetics at beta1-receptor sites. Where are these sites mainly located?

heart

A client is admitted with a myocardial infarction and atrial fibrillation. While auscultating the heart, the nurse notes an irregular heart rate and hears an extra heart sound at the apex after the S2 that remains constant throughout the respiratory cycle. The nurse should document these findings as:

heart rate irregular with S3

A client is admitted with a myocardial infarction and atrial fibrillation. While auscultating the heart, the nurse notes an irregular heart rate and hears and extra heart sound at the apex after the S2 that remains constant throughout the respiratory cycle. How should the nurse document these findings?

heart rate irregular with S3

A client has risk factors for coronary artery disease, including smoking cigarettes, eating a diet high in saturated fat, and leading a sedentary lifestyle. The nurse can coach this client to improve health by:

helping the client establish a wellness vision to reduce the health risks.

Which are indications that a client with a history of left sided heart failure is developing pulmonary edema? Select all that apply

hoarse crackles tachycardia

A 68-year-old client on day 2 after hip surgery has no cardiac history but reports having chest heaviness. The nurse should first:

inquire about the onset, duration, severity, and precipitating factors of the heaviness.

A client has a total serum cholesterol level of 326 mg/dL (8.44 mmol/L). The nurse explains to the client that this level:

is high and will require dietary modification.

A client has had a pulmonary artery catheter inserted in performing hemodynamic monitoring with the catheter, the nurse wedges the catheter. What information will the nurse obtain from this procedure?

left end-diastolic pressure

When assessing an older adult, the nurse finds the apical impulse below the fifth intercostal space. The nurse should further assess the client for:

left ventricular enlargement

A nurse is teaching a client who receives nitrates for the relief of chest pain. Which instruction should the nurse emphasize?

lie down or sit in a chair for 5 to 10 minutes after taking the drug

A client is taking metoprolol and hydrochlorothiazide. The medication is effective if it:

lowers the blood pressure.

Which is the most important initial post procedure nursing assessment for a client who has had a cardiac catheterization?

observe neurologic function every 15 mins

The nurse teaches a client with heart failure to take oral furosemide in the morning. What is the expected outcome for taking this drug in the morning? The client will:

obtain more sleep

A nurse is caring for a client who had a three-vessel coronary bypass graft 4 days earlier. His cholesterol profile is as follows: total cholesterol 265 mg/dl (6.845 mmol/L), low-density lipoprotein (LDL) 139 mg/dl (3.603 mmol/L), and high-density lipoprotein (HDL) 32 mg/dl (0.829 mmol/L). The client asks the nurse how to lower his cholesterol. The nurse should tell the client that:

she'll ask the dietitian to talk with him about modifying his diet.

A client is scheduled for an arteriogram. The nurse should explain to the client that the arteriogram will confirm the diagnosis of occlusive arterial disease by:

showing the location of the obstruction and the collateral circulation.

Which is the most appropriate diet for a client during the acute phase of a myocardial infarction (MI)?

small, easily digested meals

Which is the most appropriate diet for a client during the acute phase of myocardial infarction?

small, easily digested meals

The client who experiences angina has been told to follow a low cholesterol diet. Which meal would be best? 1. hamburger, salad, and milk shake

spaghetti with tomato sauce, salad, and coffee

A client with migraine headaches and a history of angina asks the nurse why the physician does not prescribe one of the newer medications for migraine, such as sumatriptan. The nurse responds that:

sumatriptan is contraindicated in clients with angina.

The nurse notices that a client's heart rate decreases from 63 to 50 bpm on the monitor. The nurse should first:

take the client's blood pressure

A client is admitted with chest pain and kept overnight for stress testing the next morning. Prior to sending the client to the stress test, the nurse reviews the results of the laboratory reports (see lab report). The nurse should report which elevated laboratory value to the health care provider (HCP) prior to the stress test?

troponin

A client is admitted with chest pain and kept overnight for stress testing the next morning. Prior to sending the client to the stress test, the nurse reviews the results of the laboratory reports (see lab report). The nurse should report which elevated laboratory value to the healthcare provider (HCP) prior to the stress test?

troponin

A client is scheduled for a cardiac catheterization. The nurse should do which preprocedure tasks? Select all that apply

verify that written consent has been obtained check for iodine sensitivity withhold food and oral fluids before the procedure

A client is scheduled for a cardiac catheterization the nurse should do which person preprocedure tasks? Select all that apply

verify the client has stopped taking anticoagulants if instructed by the health care provider check for iodine sensitivity verify that written consent has been obtained withhold food in oral fluids before the procedure

The nurse should teach the client that signs of digoxin toxicity include:

visual disturbances such as seeing yellow spots

The nurse is coaching an older adult who has been diagnosed with high serum lipids and leads a sedentary life-style. The goal is to increase the amount of exercise this client currently performs. After assessing the client's interests and setting an acceptable goal with the client, which exercise will offer the client the most health benefits while being practical to implement?

walking three to five times per week for 30 to 60 minutes

An anxious client who suffered an acute myocardial infarction is transferred from the coronary care unit to the telemetry unit. The client asks the charge nurse if he can have the same nurse care for him every day. How should the charge nurse respond?

we will try to assign you the same nurse as often as possible

A client is scheduled to have a graded exercise test. The nurse explains to the client that the test will determine how:

well the body reacts to controlled exercise stress

Before a transesophageal echocardiogram, a nurse gives a client an oral topical anesthetic spray. When the client returns from the procedure, the nurse observes that he has no active gag reflex. In response, the nurse should:

withhold food and fluids.

Within the physiology of the heart, each chamber has a particular role in maintaining cellular oxygenation. Which chamber of the heart is responsible for receiving oxygenated blood from the lungs?

Left Atrium

The physician refers the client with unstable angina for a cardiac catheterization. The nurse explains to the client that this procedure is being used in this specific case to:

Assess the extent of arterial blockage.

The clinic nurse caring for a client with a cardiovascular disorder is performing an assessment of the client's pulse. Which of the following steps is involved in determining the pulse deficit?

Count the heart rate at the apex

The nurse is caring for an elderly client with left-sided heart failure. When auscultating lung sounds, which adventitious sound is expected?

Crackles

Within the physiology of the heart, each chamber has a particular role in maintaining cellular oxygenation. Which chamber of the heart is responsible for pumping blood to all the cells and tissues of the body?

Left ventricle

An older, sedentary adult may not respond to emotional or physical stress as well as a younger individual because of:

Left ventricular atrophy.

A client is admitted with a myocardial infarction and new onset atrial fibrillation. While auscultating the heart, the nurse notes an irregular heart rate and hears an extra heart sound at the apex after the S2 that remains constant throughout the respiratory cycle. The nurse should document these findings as:

Heart rate irregular with aortic regurgitation.

The nurse admits a 52-year-old woman with a medical diagnosis of "rule out MI." The client is very frightened and expresses surprise that a woman would have heart problems. Which of the following responses by the nurse would be most appropriate?

"A women's heart is smaller and has smaller arteries that become occluded more easily"

A nurse is preparing a client for a scheduled Adenocard (adenosine) stress test. Which of the following statements by the client indicates a need for further teaching?

"My wife is bringing me a cup of coffee to drink before the test."

When teaching a client with heart failure about preventing complications and future hospitalizations, which problems stated by the client as reasons to call the physician would indicate to the nurse that the client has understood the teaching? Select all that apply. 1. Becoming increasingly short of breath at rest. 2. Weight gain of 2 lb or more in 1 day. 3. High intake of sodium for breakfast. 4. Having to sleep sitting up in a reclining chair. 5. Weight loss of 2 lb in 1 day.

1. Becoming increasingly short of breath at rest. 2. Weight gain of 2 lb or more in 1 day. 4. Having to sleep sitting up in a reclining chair.

When teaching the client with myocardial infarction (MI), the nurse explains that the pain associated with MI is caused by:1. Left ventricular overload

Insufficient oxygen reaching the heart muscle.

The nurse is tracking data on a group of clients with heart failure who have been discharged from the hospital and are being followed at a clinic. Which of the following data indicate that nursing interventions of monitoring and teaching have been effective?

5 percent of the clients required hospitalization in the last 90 days.

A client has a throbbing headache when nitroglycerin is taken for angina. The nurse should instruct the client that: 1. Acetaminophen (Tylenol) or Ibuprofen (Advil) can be taken for this common side effect. 2. Nitroglycerin should be avoided if the client is experiencing this serious side effect. 3. Taking the nitroglycerin with a few glasses of water will reduce the problem. 4. The client should lie in a supine position to alleviate the headache.

Acetaminophen (Tylenol) or Ibuprofen (Advil) can be taken for this common side effect.

The nurse is caring for a client with an elevated blood pressure and no previous history of hypertension. At 0900, the blood pressure was 158/90 mm Hg. At 0930, the blood pressure is 142/82 mm Hg. The nurse is most correct when relating the fall in blood pressure to which structure?

Barorecptors

A nurse assessing a client who underwent cardiac catheterization finds the client lying flat on the bed. His temperature is 99.8° F (37.7° C). His blood pressure is 104/68 mm Hg. His pulse rate is 76 beats/minute. She detects weak pulses in the leg distal to the puncture site. Skin on the leg is cool to the touch. The puncture site is dry, but swollen. What is the most appropriate action for the nurse to take?

Contact the physician and report her findings.

The client with a diagnosis of heart failure reports frequently awakening during the night with the need to urinate. The nurse offers which explanation?

Edema is collected in dependent extremities during the day; at night when the client lays down, it is reabsorbed into the circulation and excreted by the kidneys.

Within the heart, several structures and several layers all play a part in protecting the heart muscle and maintaining cardiac function. The inner layer of the heart is composed of a thin, smooth layer of cells, the folds of which form heart valves. What is the name of this layer of cardiac tissue?

Endocardium

The nurse's discharge teaching plan for the client with heart failure should stress the importance of which of the following?

Obtaining daily weights at the same time each day

During assessment of a patient with chest pain, the nurse practitioner documents the following characteristics of chest pain: Sharp, substernal of intermittent duration, and radiating to the arms and back. According to the patient, the pain increases with inspiration and swallowing. The pain is alleviated when the patient sits upright. Based on these symptoms, the nurse suspects that the patient may be experiencing which of the following conditions?

Pericarditis

A 97-year-old client with a history of atrial fibrillation is being admitted to the assisted living center where you practice nursing. In your initial assessment, you measure his apical pulse and compare it to his peripheral pulse. The difference between the two is known as what?

Pulse deficit

A client is experiencing an irregular heartbeat. The client asks the nurse how a heartbeat occurs. The nurse explains the conduction system of the heart beginning with the sinoatrial node (SA node). Place the conduction sequence of the heart in order beginning with the SA node. Use all options.

Purkinje fibers AV node Atrial cell stimulation Bundle of His Bundle branches

A client has chest pain rated at 8 on a 10 point visual analog scale. The 12-lead electrocardiogram reveals ST elevation in the inferior leads and Troponin levels are elevated. What is the highest priority for nursing management of this client at this time?

Reduce pain and myocardial oxygen demand.

A client with acute chest pain is receiving I.V. morphine sulfate. Which of the following results are intended effects of morphine in this client? Select all that apply.

Reduces myocardial oxygen consumption. Reduces blood pressure and heart rate. Reduces anxiety and fear.

In which of the following positions should the nurse place a client with suspected heart failure?

Sitting almost upright (high Fowler's position).

Which of the following reflects the principle on which a client's diet will most likely be based during the acute phase of myocardial infarction?

Small, easily digested meals.

The client who experiences angina has been told to follow a low-cholesterol diet. Which of the following meals should the nurse tell the client would be best on her low-cholesterol diet?

Spaghetti with tomato sauce, salad, and coffee.

A nurse is aware that the patient's heart rate is influenced by many factors. The nurse understands that the heart rate can be decreased by:

Stimulation of the vagus nerve

During the previous few months, a 56-year-old woman felt brief twinges of chest pain while working in her garden and has had frequent episodes of indigestion. She comes to the hospital after experiencing severe anterior chest pain while raking leaves. Her evaluation confirms a diagnosis of stable angina pectoris. After stabilization and treatment, the client is discharged from the hospital. At her follow-up appointment, she is discouraged because she is experiencing pain with increasing frequency. She states that she visits an invalid friend twice a week and now cannot walk up the second flight of steps to the friend's apartment without pain. Which of the following measures that the nurse could suggest would most likely help the client prevent this problem?

Take a nitroglycerin tablet before climbing the stairs.

Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct the client to use the drug when chest pain occurs?

Take one tablet, then an additional tablet every 5 minutes for a total of three tablets. Call the physician if pain persists after three tablets.

The client is admitted for a scheduled cardiac catheterization. On the morning of the procedure, while assessing the client's morning laboratory values, the nurse notes a blood urea nitrogen (BUN) of 34 mg/dL and a creatinine of 4.2 mg/dL. The nurse makes it a priority to notify the physician for which of the following reasons?

The client is at risk for renal failure due to the contrast agent that will be given during the procedure.

The nurse is caring for a patient with a diagnosis of pericarditis. Where does the nurse understand the inflammation is located?

The thin fibrous sac encasing the heart

The nurse is awaiting results of cardiac biomarkers for a patient with severe chest pain. The nurse would identify which cardiac biomarker as remaining elevated the longest when myocardial damage has occurred?

Troponin T and I

When assessing a patient with left-sided heart failure, what would be noted on auscultation of lungs?

Wheezes with wet lung sounds