Unit 4: Cardiovascular

Procainamide is used only for _____ term treatment of cardiac ___________ because of serious adverse effects associated with ____ term use.

1. Short 2. Dysrhythmia 3. Long

How long can a patient be in atrial fibrillation before we can give them anticoagulant therapy?

48 hours

What is a MAP that indicates that there is inadequate perfusion?

<65 mmHg

A nurse should recognize that milrinone is contraindicated for a client who has what condition?

Acute Myocardial Infarction

The nurse in the UC is assessing a patient with sudden onset irregular palpitations, fatigue, and dizziness. The nurse finds a rapid irregular HR and pulse. Which dysrhythmia would be expected on the ECG?

Atrial Fibrillation

A nurse is teaching a client who has a new prescription for gemfibrozil. Which of the following instruction should the nurse include? Select all that apply. A. "Frequent PPT testing is needed." B. "Report any new intolerance to fried foods." C. "Report muscle tenderness" D. "It's okay if you miss multiple doses." E. "Expect periodic liver function testing"

B. "Report any new intolerance to fried foods." C. "Report muscle tenderness" E. "Expect periodic liver function testing"

A nurse is teaching a client with stable angina about the factors that increase myocardial oxygen demand (workload). Which factors should be included in the teaching? Select all that apply. A. Hypovolemia and anemia B. Aortic stenosis C. Angina in a patient with atherosclerosis D. Sympathetic stimulation by drugs, stress, emotions or exertion

B. Aortic stenosis C. Angina in a patient with atherosclerosis D. Sympathetic stimulation by drugs, stress, emotions or exertion

Two hours after cardiac catheterization that was accessed via the right femoral artery route, an adult client complains of numbness and pain in the right foot. What action should the nurse take first? A. Call the provider immediately. B. Check the client's peripheral pulses (pedal/posterior tibial). C. Take the client's blood pressure. D. Recognize that this is an expected response and reassess the patient in 1 hour.

B. Check the client's peripheral pulses (pedal/posterior tibial). Rationale: Complications after accessing the femoral artery are bleeding or clotting of the vessel. Any complaint of the patient must be assessed immediately. The nurse assesses limb perfusion as the priority intervention and then notifies the healthcare provider of the results of the findings.

A patient in the coronary care unit develops ventricular fibrillation. The first action the nurse should take is to: A. Perform defibrillation B. Initiate cardiopulmonary resuscitation C. Prepare for synchronized cardioversion D. Administer IV antidysrhythmic drugs per protocol

B. Initiate cardiopulmonary resuscitation

The nurse completes teaching the client about CAD and self-care at home. The nurse determines the teaching is effective when the client makes which statements? Select all that apply. A. "I should always take 3 nitroglycerine tablets 5 minutes apart" B. "I should carry my nitroglycerin in my front pants pocket so it is handy" C. "I plan to stay away from people when they are smoking" D. "If I have chest pain, I should contact my HCP immediately" E. "If I have chest pain, I stop the activity and chew a nitroglycerin tablet" F. "I plan on walking most days of the week for at least 30 minutes"

C. "I plan to stay away from people when they are smoking" F. "I plan on walking most days of the week for at least 30 minutes"

The client with a left anterior descending (LAD) 90% blockage has crushing chest pain that is unrelieved by taking 3 nitroglycerine tablets. Which ECG finding is most concerning and should alert the nurse to immediately notify the HCP? A. Flipped T waves B. Q waves C. ST-segment elevation D. Peaked T waves

C. ST-segment elevation Rationale: The nurse should be most concerned about ST elevation because it indicates an evolving MI. The presence of Q waves indicates an MI over 24 hours old. Flipped T waves indicate myocardial ischemia. Peaked T waves may indicate hyperkalemia and are concerning, but ST-segment elevation is more concerning.

A patient's cardiac rhythm is sinus bradycardia with a heart rate of 34 bpm. If the bradycardia is symptomatic, the nurse would expect the patient to exhibit: A. Palpitations B. Hypertension C. Warm, flushed skin D. Shortness of breath

D. Shortness of breath

A nurse is caring for a client who is taking amiodarone to treat atrial fibrillation. The nurse should instruct the client to avoid what food while taking this drug?

Grapefruit Juice

A nurse is caring for a client who is taking carvedilol and a prescription for oral antidiabetic to manage their new diagnosis of type 2 DM. By taking both drugs concurrently, the nurse should identify that the client is at an increased risk for what condition?

Hypoglycemia

What is Mean Arterial Pressure (MAP)?

Is a calculation that measures the blood perfusion to organs.

How do you calculate MAP?

MAP = (SBP + 2DBP)/3

A nurse is caring for a client who is taking atorvastatin and has a new prescription for gemfibrazil. The nurse should recognize that this drug combination places the client at risk for what following adverse effect?

Myopathy

A nurse is caring for a client with a new prescription for propranolol to treat tachydysrhythmia. The nurse should instruct the client to avoid taking which type of over-the-counter drug while taking propranolol?

NSAIDs

What does ONAM stand for regarding the treatment of an MI STEMI or NSTEMI?

O= Oxygen N= Nitrates A= Aspirin M= Morphine

What does the PQRST assessment stand for?

Precipitating events Quality of pain Radiating Severity Time

A nurse is teaching a client with a prescription for quinidine. What should the patient monitor and report if there are changes?

Pulse Rate

A nurse is caring for a client who has a depressive disorder and requires a prescription drug to treat hypertension. The nurse should recognize that which hypertensive drug is contraindicated for the client?

Reserpine

Hypertension is the S_____ K_____.

Silent Killer

True or False: Clopidogrel is used to prevent blood clots

True

A patient has a diagnosis of acute myocardial infarction and his cardiac rhythm is sinus bradycardia with 6 to 8 premature ventricular contractions (PVCs) per minute. The pattern that the nurse recognizes as the most characteristics of PVCs is: A. An irregular rhythm B. An inverted T wave C. A wide, distorted QRS Complex D. An increasing long PR interval

C. A wide, distorted QRS Complex

A nurse obtains several STAT verbal prescriptions from the HCP for a client experiencing an acute myocardial infarction. In what order should the nurse complete the following actions? -Nitroglycerin (NTG) 0.4 mg SL x 3 PRN for pain -Consult Cardiologist -Obtain BP and HR -Read back the verbal orders -Morphine 2-4 mg IV PRN for pain unrelieved by NTG

1. Read back the verbal orders 2. Obtain BP and HR 3. Nitroglycerin (NTG) 0.4 mg SL x 3 PRN for pain 4. Morphine 2-4 mg IV PRN for pain unrelieved by NTG 5. Consult Cardiologist

Match the correct answers: A. Left Heart Failure B. Right Heart Failure 1. Pulmonary depression 2. Fluid retention in body and JVD

A to 2 B to 1

A nurse is caring for a client who will begin using transdermal nitroglycerin to treat angina pectoris. When speaking to the client about the drug, which of the following instructions should the nurse include? Select all that apply. A. "Apply the patch to a hairless area and rotate sites." B. "You can re-use the same patch from the previous day" C. "Apply a new patch when you start of your day." D. "Remove patches 10 to 12 hours each day." E. "You don't need to wear gloves when applying the patch."

A. "Apply the patch to a hairless area and rotate sites." C. "Apply a new patch when you start of your day." D. "Remove patches 10 to 12 hours each day."

Which accurately describes the PR interval? (Select all that apply) A. 0.12 to 0.20 seconds B. Measured from the beginning of the p wave to the beginning of the QRS complex C. <0.12 seconds D. 0.06 to 0.12 seconds E. Time of depolarization and repolarization of ventricles

A. 0.12 to 0.20 seconds B. Measured from the beginning of the p wave to the beginning of the QRS complex

Which rhythm pattern finding is indicative of PVCs? A. A QRS complex greater than 0.12 seconds followed by a P wave B. Continuous wide QRS complexes with a ventricular rate of 160 bpm C. P waves hidden in QRS complexes, with a regular rhythm of 120 bpm D. Saw-toothed P waves with no measurable PR interval and an irregular rhythm

A. A QRS complex greater than 0.12 seconds followed by a P wave

The nurse prepares medications for a patient with hypertension and acute decompensated HF. The nurse knows that which of the following medications will decrease the afterload? Select all that apply. A. losartan B. bisoprolol C. dalteparin D. isosorbide dinitrate E. diltiazem

A. losartan B. bisoprolol D. isosorbide dinitrate E. diltiazem

A nurse is caring for a client who is taking to digoxin and develops changes on the ECG tracing and other manifestations that indicates the client has severe digoxin toxicity. Which type of drugs should the nurse expect to administer to treat this complication?

Antigen binding fragments

The patient had an MI two weeks ago. Their troponin levels are elevated. Should the nurse call the health care provider? A. Yes B. No

B. No Rationale: Troponin levels can stay elevated for up to two weeks after the patient had an MI.

A nurse is caring for a client who is taking a diuretic. The nurse should instruct the client to include which of the following foods in their diet to increase potassium intake. A. Carrots B. Raisins C. Oranges D. Whole Grains

B. Raisins

What lab must be obtained on a patient before going to a Coronary Computed Tomography Angiography (CCTA)? A. Platelet Aggregation B. Serum Creatinine C. Potassium D. Hemoglobin

B. Serum Creatinine Rationale: IV contrast dye can worsen renal function.

A nurse is monitoring a client who is taking a loop diuretic and is experiencing a thready, irregular pulse, orthostatic hypotension, and confusion. The nurse should identify that these manifestations indicate what adverse effect?

Hypokalemia

True or False: Hyperuremia is an adverse effect of hydrochlorothiazide.

True

A nurse is caring for a client with a glomerular filtration rate of 10 mL/min and reduced urine output. The nurse should clarify hydrochlorothiazide does not promote ________ for clients who have renal insufficiency.

diuresis

True or False: A nurse is caring for a client who has a prescription for verapamil. The nurse should clarify the prescription with the provider if the client has a history of Second Degree AV Block.

True

True or False: A nurse is teaching a client with a new prescription for nitroglycerin that the manifestation of a headache is a potential adverse effect of the drug.

True

What does the nurse recognize as an absolute contraindication for thrombolytic therapy? A. Active Bleeding B. Current Anticoagulant Therapy C. Over the age of 75 D. Severe Hepatic Disease

A. Active Bleeding Rationale: Because bleeding is a major complication of thrombolytic therapy, any patient with active bleeding should not be administered this treatment.

The client who had a synthetic valve replacement a year ago is hospitalized with unstable angina. IV heparin and nitroglycerin infusions were started, but then nitroglycerin was discontinued after the pain resolved. The HCP prescribes starting oral warfarin 5 mg at 1900 hours. Which is the nurse's best action? A. Administer the warfarin as prescribed. B. Call the HCP to question starting warfarin. C. Discontinue heparin then give warfarin. D. Hold warfarin until heparin is discontinued.

A. Administer the warfarin as prescribed.

The nurse is caring for a client who had a cardiac valve replacement. To decrease the risk of DVT and PE, which interventions should the nurse plan to include? Select all that apply. A. Apply a pneumatic compression device. B. Administer heparin subcutaneously. C. Encourage coughing and deep breathing hourly. D. Teach about performing isometric leg exercises. E. Avoid the use of graded compression elastic stockings.

A. Apply a pneumatic compression device. B. Administer heparin subcutaneously. D. Teach about performing isometric leg exercises.

The nurse is interpreting the ECG of a patient who has bradycardia which of the following should the nurse identify as the role of the p wave? A. Atrial depolarization B. Ventricular depolarization C. Slow repolarization of the ventricle D. Early ventricular repolarization

A. Atrial depolarization

What describes the SA node's inability to discharge an electrical impulse spontaneously? A. Automaticity B. Conductivity C. Contractility D. Conductivity

A. Automaticity

A patient on the cardiac telemetry unit goes into V. Fib and is unresponsive. The nurse has initiated the code team response. What is the next priority for the nurse in caring for the patient? A. Begin CPR B. Get the code cart C. Administer Amiodarone IV D. Defibrillate with 360 joules

A. Begin CPR

The nurse is caring for a patient taking digoxin to treat heart failure. Which of the following is a manifestation of digoxin toxicity? A. Report of anorexia B. Bruising C. Report of metallic taste D. Muscle Pain

A. Report of anorexia

The nurse is caring for a patient admitted with chest pain. The patient reports the pain began during a staff meeting and went away after 3 nitro's. What type of pain is this most likely? A. Stable Angina B. Unstable Angina C. Variant Angina D. Prinzmetal's Angina

A. Stable Angina Rationale: Because it can occur during emotional stress or exertion. It is generally relieved by rest or nitroglycerin.

The nurse receives the client after having a cardiac catheterization. What is the best position for the client to be placed in? A. Supine with affected leg flat B. Trendelenburg with both legs flat C. Semi-fowler's with the affected leg slightly elevated D. Left lateral recumbent with the affected leg in a dependent position

A. Supine with affected leg flat

The nurse is teaching the client newly diagnosed with chronic stable angina. Which instructions on measures to prevent future angina should the nurse include? Select all that apply. A. Take nitroglycerin before stressful activities or events, even if pain-free B. Discontinue use of all tobacco products if you use these C. Wear a facemask when outdoors in cold weather D. Increase isometric arm exercises to build endurance E. Take a daily stool softener to avoid straining with bowel movements F. Perform most exertional activities in the morning

A. Take nitroglycerin before stressful activities or events, even if pain-free B. Discontinue use of all tobacco products if you use these C. Wear a facemask when outdoors in cold weather E. Take a daily stool softener to avoid straining with bowel movements

The most significant factor in long-term survival of a patient with sudden cardiac death is: A. Absence of underlying heart disease. B. Rapid institution of emergency services and procedures. C. Performance of perfect technique in resuscitation procedures. D. Maintenance of 50% of normal cardiac output during resuscitation efforts.

B. Rapid institution of emergency services and procedures. Rationale: Rapid cardiopulmonary resuscitation, prompt defibrillation (with an automated external defibrillator), and early advanced cardiac life support can produce high long-term survival rates for a witnessed arrest.

The nurse is assessing a client following an inferior septal wall MI. Which potential complication should the nurse further explore when noting that the client has JVD and ascites? A. Left-sided heart failure B. Right-sided heart failure C. Ruptured septum D. Pulmonic valve malfunction

B. Right-sided heart failure

A patient with dilated cardiomyopathy has a new onset of atrial fibrillation that has been unresponsive to drug therapy for several days. Upon initial treatment, the nurse needs to teach the patient which of the following? A. IV Adenosine B. Emergent cardioversion C. Anticoagulant therapy D. Permanent pacemaker

C. Anticoagulant therapy

A nurse is caring for a client with a new prescription for verapamil to treat atrial fibrillation. The nurse should instruct the client to avoid drinking grapefruit juice while taking verapamil because it can cause the client to experience which of the following? A. Hypertension B. Dizziness C. Hypotension D. Hyperkalemia

C. Hypotension

The nurse assesses the client returning from a coronary angiogram in which the femoral artery approach was used. The client's baseline BP during the procedure was 130/72 mm Hg, and the cardiac rhythm was sinus rhythm. Which finding should alert the nurse to a potential complication? A. Blood pressure of 142/78 mm Hg B. Pedal pulses palpable at +1 C. Left groin soft to palpation with 1 cm ecchymosis area D. Apical pulse of 132 bpm with irregular-irregular rhythm

D. Apical pulse of 132 bpm with irregular-irregular rhythm

The nurse is titrating IV Nitro for a patient with an MI. Which action will the nurse take to evaluate the effectiveness of the medicine? A. Check BP B. Obverse for dysrhythmias C. Monitor HR D. Ask about chest pain

D. Ask about chest pain

The client returns from a cardiac catheterization procedure with a right groin sheath in place. What should the nurse include in the priority assessment for this client? Select all that apply. A. Blood Pressure B. Temperature C. Right groin assessment D. Lung sounds E. Cardiac monitor F. Distal pulse assessment for affected extremities

A. Blood Pressure C. Right groin assessment E. Cardiac monitor F. Distal pulse assessment for affected extremities

A patient with ST-segment elevation and 3 continuous ECG leads is admitted to the ED and diagnosed with ST-segment elevation, and a STEMI. Which question should the nurse ask to determine if the patient is a candidate for thrombolytic therapy? A. Can you rate your chest pain on a scale of 0-10? B. What time did chest pain begin? C. Do you chew aspirin on a daily basis? D. Do you take blood thinners on a daily basis?

B. What time did chest pain begin?

The nurse is caring for a patient post percutaneous coronary intervention (PCI). Which of the following nursing interventions post-procedure are required? Select all that apply. A. Check for a pulse in all the affected extremities B. Place the patient in high fowlers position C. Keep the head of the bed no higher than 30 degrees for 2 to 6 hours D. Measure Vital Signs every 4 hours E. Keep the patient's hip and leg extended F. Have the patient remain in bed for up to 6 hours

A. Check for a pulse in all the affected extremities E. Keep the patient's hip and leg extended F. Have the patient remain in bed for up to 6 hours

The nurse is caring for a patient with impaired cardiac output from dysrhythmia. Which of the following findings would the nurse anticipate? A. Chest pain and decreased mentation B. Hypertension and bradycardia C. Abdominal distention and hepatomegaly D. Bounding pulse and ventricular heave

A. Chest pain and decreased mentation

A patient's rhythm strip indicates a normal HR and rhythm, a normal P wave and QRS complexes, but the PR interval is 0.26 seconds. What is the most appropriate action by the nurse? A. Continue to assess the patient B. Administer atropine per protocol C. Prepare the patient for cardioversion D. Prepare the patient for placement of a temporary pacemaker

A. Continue to assess the patient

For a patient experiencing ventricular fibrillation, what is the rationale for using cardiac defibrillation? A. Depolarize the cells of the myocardium to allow the SA node to resume pacemaker function B. Enhance repolarization and relaxation of ventricular myocardial cells C. Provide an electrical impulse that stimulates normal myocardial contractions D. Deliver an electrical impulse to the heart at the time of ventricular contraction to convert the heart to a sinus.

A. Depolarize the cells of the myocardium to allow the SA node to resume pacemaker function

A patient asks what they can do to help decrease the risk for having another MI in the future. What should the nurse instruct? Select all that apply. A. Eat a diet low in cholesterol and saturated fats B. Minimize carbohydrate intake C. Walk 30 minutes 5 days a week D. Increase dietary intake of fruit E. Monitor serum lipid levels

A. Eat a diet low in cholesterol and saturated fats B. Minimize carbohydrate intake C. Walk 30 minutes 5 days a week E. Monitor serum lipid levels

A nurse is providing teaching to a client Who has a new prescription for losartan to treat hypertension. The nurse should instruct the client on which of the following findings could indicate an adverse reaction to the drug that needs to be reported. A. Facial Edema B. Rash C. Vision Changes D. Orthostatic Hypotension

A. Facial Edema

A nurse is caring for a client with a new prescription for aliskiren to treat hypertension. The nurse should monitor the client for which of the following adverse effects of the drug? Select all that apply. A. Hyperkalemia B. Hypokalemia C. Throat swelling. D. Dry Mouth E. Cough

A. Hyperkalemia C. Throat swelling E. Cough

The nurse is assessing the client following cardiac surgery. Which assessment findings should be of the greatest concern to the nurse? A. Jugular vein distension, muffled heart sounds, and BP 84/48. B. Temperature 96.4F (35.8C), heart rate of 58 bpm, and shivering. C. Increased heart rate, audible S1 and S2, and pain rated at a 5. D. Central venous pressure 4 mm Hg, urine output 30 mL/hr, and sinus rhythm with a few PVCs.

A. Jugular vein distension, muffled heart sounds, and BP 84/48.

The nurse has prepared medications for a 75-year-old client with hypertension. The nurse notes that the client has an elevated serum potassium level. Which medication is most important for the nurse to address with the HCP before administration? A. Lisinopril B. Metoprolol C. Atorvastatin D. Sertraline

A. Lisinopril Rationale: Hyperkalemia can occur as a side effect of lisinopril (Prinivil, Zestril), an ACE inhibitor. The HCP should be notified prior to administration. The drug or dose may need to be changed; 40mg is the maximum daily dose for an elderly client.

A nurse is caring for a client with a new prescription for dobutamine. The nurse should clarify the prescription if the client is receiving which of the following types of drugs? Select all that apply. A. MAOI B. General anesthetic C. Tricyclic antidepressant D. Beta blocker E. Ace Inhibitor

A. MAOI B. General anesthetic C. Tricyclic antidepressant D. Beta blocker

The nurse is caring for a patient who is prescribed isosorbide mononitrate for chronic stable angina and develops reflex tachycardia. Which of the following medications will the nurse expect to administer? A. Metoprolol B. Furosemide C. Norepinephrine D. Ranolazine

A. Metoprolol

The nurse is caring for a patient with chronic stable angina and is about to be administered amlodipine. The nurse understands that the primary effect of this medication is what? A. Negative inotropic and negative chronotropic effects. B. Positive inotropic and positive chronotropic effects. C. Positive inotropic and negative chronotropic effects. D. Negative inotropic and positive chronotropic effects.

A. Negative inotropic and negative chronotropic effects.

The client is admitted with the acute coronary syndrome (ACS). Which should be the nurse's priority assessment? A. Pain B. Blood Pressure C. Respiratory Rate D. Heart Rate

A. Pain Rationale: Pain is an indicator of whether or not the heart is getting oxygen and blood

The nurse is caring for a patient with an acute MI, who is having multifocal PVCs and couplets. The patient is alert, and oriented, and has a BP of 120/80, and an irregular pulse of 86 bpm. What is the priority nursing action at this time? A. Prepare to administer an antidysrhythmic B. Continue to assess the patient C. Be prepared to begin CPR D. Ask the patient to perform the Valsalva maneuver

A. Prepare to administer an antidysrhythmic

A nurse is caring for a client who is about to begin captopril therapy. Which of the following adverse effects should the nurse instruct the client to report because it could indicate a need to discontinue therapy? Select all that apply. A. Rash B. Fatigue C. Distorted Taste D. Swelling of the tongue E. Dry cough

A. Rash C. Distorted Taste D. Swelling of the tongue E. Dry cough

The client is scheduled for a coronary artery bypass graft in one week. Which instructions should the nurse provide to the client? Select all that apply. A. Stop taking aspirin now and any products containing aspirin. B. . Do perform aerobic exercises 30 minutes daily before surgery. C. Use the prescribed antimicrobial soap before hospital arrival. D. Shave your chest and legs and then shower to remove the hair. E. Resume normal activities when discharged from the hospital.

A. Stop taking aspirin now and any products containing aspirin. C. Use the prescribed antimicrobial soap before hospital arrival. D. Shave your chest and legs and then shower to remove the hair.

A nurse is caring for a client who is taking spironolactone to treat hypertension. Does a potassium level of 5.2 mEq/L require immediate intervention? A. Yes B. No

A. Yes

If a patient has an allergy to IV contrast dye, would you still schedule them for a Coronary Computed Tomography Angiography (CCTA)? A. Yes B. No

A. Yes Rationale: Patients can be premedicated with an antihistamine such as Benadryl or a corticosteroid such as Prednisone

A nurse is assessing a patient with acute decompensated HF with fluid overload. What findings would the nurse expect? Select all that apply. A. increase HR B. increase BP C. increase RR D. increase Hct E. increase PaCO2

A. increase HR B. increase BP C. increase RR

The nurse is caring for a nonsmoking female patient with the diagnosis of coronary atherosclerosis who has been admitted to the hospital with angina. The patient states that she never experiences chest pain going down her arm or in the middle of her chest. The nurse is not surprised at this statement and explains to the patient: A. Women who have ischemia are usually totally asymptomatic. B. Women have been found to have more atypical symptoms such as dyspnea, nausea, and weakness. C. Chest pain occurs only with strenuous exercise. D. Cigarette smoking is usually the contributing factor to chest pain.

B. Women have been found to have more atypical symptoms such as dyspnea, nausea, and weakness. Rationale: Women with acute coronary syndromes report atypical symptoms such as indigestion, nausea, fatigue, and palpitations rather than chest pain.

A 54-year-old man comes to triage complaining of severe, left-sided, pressure-like chest pain and left arm numbness. The pain began 2 hours ago and is unrelieved by rest. The patient is anxious, diaphoretic, and complaining of nausea. Cardiac monitoring is begun, and oxygen is given at 2 L/min. An intermittent infusion device (IID) is in place, and vital signs are as follows: BP of 128/68 mm Hg; pulse, 76 beats/min; respirations easy and regular at 20 breaths/min. ECG reveals normal sinus rhythm with occasional unifocal premature ventricular contractions (PVCs). The nurse suspects an MI based on an elevation in which lab study? A. CK-MB and LDH B. LDH and troponin I C. CK-MB and troponin I D. Troponin I and SGPT

C. CK-MB and troponin I Rationale: CK-MB is an enzyme specific to myocardial muscle and is released when there has been damage to the muscle; therefore, it will be present when there has been an MI. Additionally, troponin I is a protein that is released exclusively from the myocardial muscle; therefore, a "positive" troponin I is indicative of an MI.

After administering 4 mg of morphine sulfate IV for chest pain, the nurse discovers that the consent for an emergent coronary angiogram was not signed. The assessment shows that the client is alert, oriented and pain-free. What should the nurse do next? A. Obtain signature before morphine peaks in the bloodstream B. Notify the cardiologist and cancel the procedure C. Determine if a power of attorney is available D. Ask the client's teenage son, who is at the bedside, to sign the consent

C. Determine if a power of attorney is available

After an acute MI, the patient ambulates in the hospital hallway. The nurse evaluates the patient's response to physical activity. Which data indicates the patient needs to decrease their physical activity? A. BP went from 118/60 to 126/68 B. RR went from 14 to 20 C. HR went from 66 to 98 D. SPO2 went from 99% to 92%

C. HR went from 66 to 98

The nurse is providing teaching to a client who is taking simvastatin. The nurse should instruct the client to report which of the following manifestations is an indication of a serious adverse reaction that could require discontinuation of the drug therapy? A. Weakness B. Anorexia C. Muscle Pain D. Nausea & Vomiting

C. Muscle Pain

You see sinus bradycardia on the monitor, which action is the first priority? A. Administer IV atropine push B. Notify the provider immediately C. Obtain BP D. Call for rapid response

C. Obtain BP

A patient is admitted to the coronary care unit following a cardiac arrest and successful cardiopulmonary resuscitation. When reviewing the health care provider's admission orders, which order should the nurse question? A. Oxygen at 4 L/min per nasal cannula B. Morphine sulfate 2 mg IV every 10 minutes until the pain is relieved C. Tissue plasminogen activator (tPA) 100 mg IV infused over 3 hours D. IV nitroglycerin at 5 mcg/minute and increase 5 mcg/minute every 3 to 5 minutes

C. Tissue plasminogen activator (tPA) 100 mg IV infused over 3 hours Rationale: Traumatic or prolonged (>10 minutes) cardiopulmonary resuscitation is a relative contraindication for the administration of fibrinolytic therapy.

A patient arrives in the emergency room complaining of nausea, diaphoresis, SOB, and squeezing substernal chest pain that radiates to the left shoulder and jaw. The nurse should perform which interventions? A. Complete admission registration, alert the catheter lab team, establish an IV access, and record all vital signs. B. Alert the cat lab team, administer oxygen, obtain blood work, and notify the health care provider. C. Establish an IV, give sublingual nitroglycerin as ordered, insert a foley catheter, and alert the catheter lab team. D. Administer oxygen, apply a cardiac monitor, record the patient's vital signs, and give sublingual nitroglycerin as ordered.

D. Administer oxygen, apply a cardiac monitor, record the patient's vital signs, and give sublingual nitroglycerin as ordered. Rationale: The patient must be assessed before alerting the laboratory team; therefore, vital sign assessment is a priority, and the nurse recalls the mnemonic MONA and anticipates the administration of morphine, oxygen, nitroglycerine (Nitrates), and aspirin.

The nurse identifies a patient who has a new onset of atrial fibrillation. The patient was a direct admission from their PCP's office. The patient is non-symptomatic with the following vital signs: BP of 156/72, HR of 164, RR of 12, and T of 98.9. Which of the following orders should be implemented first? A. Prepare a 500 ml fluid bolus B. Prepare to administer adenosine C. Assess the patient for orthostatic hypotension D. Assess serum K levels

D. Assess serum K levels

The nurse, assessing the client hospitalized following an MI, obtains these vital signs: BP 78/38 mm Hg, HR 128, RR 32. The nurse notifies the HCP concerned that the client may be experiencing which most life-threatening complication. A. Pulmonary embolism B. Cardiac tamponade C. Cardiomyopathy D. Cardiogenic shock

D. Cardiogenic shock

Which lab value result for a patient experiencing multiple PVCs is the most important for the nurse to tell the provider? A. Mg 1.5 B. Na 130 C. Cl 88 D. K 2.9

D. K 2.9

The nurse is caring for a group of patients in a cardiac monitor unit. Which patient needs the most immediate action? A. Patient with stable angina being prepped for an echocardiogram B. Patient with CAD and history of uncontrolled HTN and a current BP of 172/98 C. Patient that is 3 days post MI with a temperature of 102.0 D. Patient that was admitted today with stable angina and increased chest pain

D. Patient that was admitted today with stable angina and increased chest pain

The nurse is admitting a client experiencing dyspnea from HF and COPD with high CO2 levels. What immediate intervention would the nurse do? A. Apply oxygen 6 liters per nasal cannula. B. Weigh daily in the A.M. after the client voids. C. Teach pursed-lip breathing techniques. D. Place the client in a high Fowler position.

D. Place the client in a high Fowler position.

The nurse is caring for a patient immediately following the insertion of a permanent pacemaker via the right subclavian vein approach. Which intervention should the nurse include in the client's plan of care to best prevent pacemaker lead dislodgment? A. Request a STAT chest x-ray upon return from the procedure B. Inspect the incision for bleeding and approximation C. Assist the client with using a walker when out of bed D. Prevent the right arm from extending above shoulder level

D. Prevent the right arm from extending above shoulder level Rationale: In the first several hours after insertion of either a permanent or temporary pacemaker, the most common complication is pacing electrode dislodgment. The nurse helps prevent this complication by limiting the client's activities.

A nurse is reviewing new prescriptions for a client with heart failure. The nurse should instruct the client that which of the following drugs is prescribed to treat Hypercholesteremia? A. Lisinopril B. Propranolol C. Digoxin D. Simvastatin

D. Simvastatin

A patient is admitted to the telemetry unit for atrial flutter. Which of the following medications will the nurse prepare to administer? A. lisinopril B. nitro drip C. isosorbide dinitrate D. diltiazem

D. diltiazem