MED-SURG, 1010-011 CoursePt26.docx | Download To Score An A

CoursePCoursePt 26 A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching? Ill keep a log of each time my ICD discharges The nursing student asks the nurse to describe the difference between sinus rhythm and sinus bradycardia on the electrocardiogram strip. What is the nurse's best reply? The only difference is the heart rate The nursing student asks the nurse how to tell the difference between ventricular tachycardia and ventricular fibrillation on an electrocardiogram strip. What is the best response? Ventricular fibrillation is irregular and fast, with wide QRS complexes The nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor. What is the priority nursing intervention for the client? Altering the healthcare provider of the third-degree heart block The nurse is working on a telemetry unit, caring for a client who develops dizziness and a second-degree heart block, Mobitz Type 1. What will be the initial nursing intervention? Administer an IV bolus of atropine A nurse is caring for a client who has been admitted to have a cardioverter defibrillator implanted. The nurse knows that implanted cardioverter defibrillators are used in which clients? Clients with recurrent life-threatening tachydysrhythmias The nurse cares for a client with a dysrhythmia and understands that the P wave on an electrocardiogram (ECG) represents which phase of the cardiac cycle? Atrial depolarization A client reports light-headedness, chest pain, and shortness of breath. They physician orders tests to ascertain what is causing the client’s problems. Which test is used to identify cardiac rhythms? Electrocardiogram The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment? A client with atrial dysrhythmias The nurse analyzes a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0.18 seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as normal sinus rhythm The nurse is caring for a client who had a permanent pacemaker surgically placed and is now ready for discharge. What statement made by the client indicates the need for more education? We will be getting rid of our microwave oven so it will not affect my pacemaker A client's Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minute. What type of dysrhythmia would the cardiologist likely diagnose? Sinus tachycardia The client has just been diagnosed with a dysrhythmia. The client asks the nurse to explain normal sinus rhythm. What would the nurse explain is the characteristic of normal sinus rhythm? The sinoartrial (SA) node initiates the impulse The nurse enters the client’s room and finds the client pulseless and unresponsive. What would be the treatment of choice for this client? Immediate defibrillation A client is admitted to the emergency department reporting chest pain and shortness of breath. The nurse notes an irregular rhythm on the bedside electrocardiograph monitor. The nurse counts 9 RR intervals on the client’s 6-second rhythm tracing. The nurse correctly identifies the client’s heart rate as 90bpm A client tells the nurse “my heart is skipping beats again; I’m having palpitations.” After completing a physical assessment, the nurse concludes the client is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the client to avoid caffeinated beverages A patient with mitral valve stenosis and coronary artery disease (CAD) is in the telemetry unit with pneumonia. The nurse assesses a 6-second rhythm strip and determines that the ventricular rhythm is highly irregular at 88, with no discernible P waves. What does the nurse determine this rhythm to be? Atrial flutter The nurse reads an athletic client's electrocardigram. What finding will be consistent with a sinus bradycardia? Heart rate of 42bpm The nurse is assessing a patient with a probable diagnosis of first- degree AV block. The nurse is aware that this dysrhythmia is evident on an ECG strip by what indication? Delayed conduction, producing a prolonged PR interval A client has been diagnosed with atrial fibrillation and has been prescribed warfarin therapy. What should the nurse prioritize when providing health education to the client? The need to have regular blood levels drawn Level 2 A client with a second-degree atrioventricular heart block, Type II is admitted to the coronary care unit. How will the nurse explain the need to monitor the client's electrocardiogram (ECG) strip to the spouse? The small box will transmit the heart rhythm to the central monitor all the time When the nurse observes that the client's heart rate increases during inspiration and decreases during expiration, the nurse reports that the client is demonstrating sinus dysrhythmia Undersensing occurs as a pacemaker malfunctions. The nurse understands undersensing occurs as a result of which event? Pacing spike occurs at the preset level The client returns to the clinic for a follow-up appointment following a permanent pacemaker insertion and reports tenderness and throbbing around the incision. The nurse observes mild swelling, erythema, and warmth at the pacemaker insertion site. What does the nurse suspect? Pacemaker site infection A client has a medical diagnosis of an advanced atrioventricular block, Mobitz Type II, and is symptomatic. What initial treatment will the nurse be prepared to complete? Administer an IV bolus of atropine The nurse knows that what PR interval presents a first-degree heart block? 0.24 seconds A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder? Atrial flutter Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with atrial fibrillation? Anticoagulant The nurse is caring for a client with second-degree atrioventricular block, Type I with symptomatic bradycardia. What is the most likely medication the nurse will administer? Atropine sulfate After evaluating a client for hypertension, a health care provider orders atenolol, 50 mg P.O. daily. Which therapeutic effect should atenolol have in treating hypertension? Decreased cardiac output and decreased systolic and diastolic blood pressure Which nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia? Monitor vital signs and cardiac rhythm The nurse, along with a nursing student, is caring for a client who is admitted with a fractured pacemaker lead related to Twiddler syndrome. The student asks for information about Twiddler syndrome. The appropriate response by the nurse is which of the following? The client twiddles with or manipulates the generator or wires, causing the lead to fracture The nurse is working with a client with a new onset of atrial fibrillation during a three-month follow-up visit. The healthcare provider is planning a cardioversion, and the client asks the nurse why there is a wait for the treatment. What is the best response by the nurse? Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion The nurse assesses a client with a heart rate of 120 beats per minute. What are the known causes of sinus tachycardia? Hypovolemia The nurse is caring for clients on a telemetry unit. Which nursing consideration best represents concerns of altered rhythmic patterns of the heart? Altered patterns frequently affect the heart’s ability to pump blood effectively The licensed practical nurse is co-assigned with a registered nurse in the care of a client admitted to the cardiac unit with chest pain. The licensed practical nurse is assessing the accuracy of the cardiac monitor, which notes a heart rate of 34 beats/minute. The client appears anxious and states not feeling well. The licensed practical nurse confirms the monitor reading. When consulting with the registered nurse, which of the following is anticipated? The registered nurse administering atropine sulfate IV The registered nurse reviewed the patient's vital signs and noted a consistent pattern of heart rate recordings between 48 and 58 bpm over a 24-hour period of time. What medication will cause bradycardia? Atenolol Two nursing students are reading EKG strips. One of the students asks the instructor what the P-R interval represents. The correct response should be which of the following? It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node The nurse is assigned to care for several clients admitted to a telemetry unit. Which clients should the nurse assess first? A client whose implantable cardioverter defibrillator (ICD) fired twice on the prior shift, requiring amiodarone IV After performing an ECG on an adult client, the nurse reports that the PR interval reflects normal sinus rhythm. What is the PR interval for a normal sinus rhythm? 0.12 and 0.2 seconds Level 3 The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. The client, an avid tennis player, is scheduled to play in a tournament in 1 week. What is the best advice the nurse can give related to this activity? You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks The nurse recognizes which as being true of cardioversion? Defibrillator should be set to deliver a shock during the QRS complex The nurse working in the emergency department places a client in anaphylactic shock on a cardiac monitor and sees the cardiac rhythm below. What dysthymia should the nurse document? Ventricular fibrillation Which postimplantation instruction must a nurse provide to a client with a permanent pacemaker? Avoid sources of electrical interference A client admitted to the telemetry unit has a serum potassium level of 6.6 mEq/L. Which electrocardiographic (ECG) characteristic is commonly associated with this laboratory finding? Peaked T waves A nurse evaluates a client with a temporary pacemaker. The client's ECG tracing shows each P wave followed by the pacing spike. What is the nurse's best response? Document the findings and continue to monitor the client LEVEL 4 To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform? P wave The nurse is teaching a beginning EKG class to staff nurses. As the nurse begins to discuss the the parts of the EKG complex, one of the students asks what the normal order of conduction through the heart is. What order does the nurse describe? SA node, AV node, bundle of his, right and left bundle branches, purkinje fibers A client asks the nurse what causes the heart to be an effective pump. The nurse informs the client that this is due to the: inherent rhythmicity of cardiac muscle tissue The client has been prescribed procainamide for a dysrhythmia. Which medication side effect will the nurse teach the client to watch for? Feeling tired The nurse recognizes that Premature ventricular contractions (PVCs) are considered precursors of ventricular tachycardia (VT) when they: occur at a rate of more than six per minute The nurse is preparing a client for upcoming electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia. What information will the nurse include in the teaching? During the procedure, the dysrhythmia will be reproduced under controlled conditions A client has been living with an internal, fixed-rate pacemaker. When checking the client's readings on a cardiac monitor the nurse notices an absence of spikes. What should the nurse do? Double-check the monitoring equipment The nurse is caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client? Fluttering A client tells the nurse “my heart is skipping beats again; I’m having palpitations.” After completing a physical assessment, the nurse concludes the client is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the client to Avoid caffeinated beverages A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be? Ventricular fibrillation Which term is used to describe a tachycardia characterized by abrupt onset, abrupt cessation, and a QRS of normal duration? Paroxysmal atrial tachycardia A client with an atrial dysrhythmia has come to the clinic for a follow-up appointment and to talk with the health care provider about options to stop this dysrhythmia. What procedure could be used to treat this client? Elective electrical cardioversion A 28-year-old client presents to the emergency department, stating severe restlessness and anxiety. Upon assessment, the client's heart rate is 118 bpm and regular, the client’s pupils are dilated, and the client appears excitable. Which action should the nurse take next? Question the client about alcohol and illicit drug use The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and “sawtooth” P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm? Atrial flutter A healthy adult client is seeing a health care provider for an annual physical examination. While the nurse is taking the client's vital signs, the client states, “Occasionally, my heart skips a beat. Is this normal?” What is the nurse's best response? Premature atrial complex Which ECG waveform characterizes conduction of an electrical impulse through the left ventricle? QRS complex The nurse is preparing to defibrillate a client with no breathing or pulse. Which nursing action precedes the nurse pressing the discharge button? Shouts “All clear” A client with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What medical treatment does the nurse anticipate the client will have to terminate the episode of ventricular fibrillation? Internal cardioverter defibrillator insertion A nursing instructor is reviewing the parts of an EKG strip with a group of students. One student asks about the names of all the EKG cardiac complex parts. Which of the following items are considered a part of the cardiac complex on an EKG strip? Choose all that apply. T wave, p-r interval, P wave The nurse is placing electrodes for a 12-lead electrocardiogram (ECG). The nurse would be correct in placing an electrode on which area for V1? Right side of sternum, fourth intercostal space The nurse analayzes the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which finding indicates the need for follow-up? Q-T interval that is 0.46seconds long When no atrial impulse is conducted through the AV node into the ventricles, the client is said to be experiencing which type of AV block? Third degree LEVEL 5 A 43-year-old male came into the emergency department where you practice nursing and was diagnosed with atrial fibrillation. It’s now 48 hours since his admittance and the dysrhythmia persists. Which of the following medications will the client’s healthcare provider most likely order? heprin The licensed practical nurse is monitoring the waveform pattern on the cardiac monitor of the client admitted following a myocardial infarction. The nurse notes that every other beat includes a premature ventricular contraction (PVC). The nurse notes which of the following in the permanent record? Bigeminy A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic? “spike” on the rhythm strip The client asks the nurse to explain what is meant by a ventricular bigeminy cardiac rhythm. What is the best response by the nurse? The rhythm has a normal beat, then a premature beat pattern LEVEL 6 When the appropriate electrocardiogram (ECG) complex follows the pacing spike, it is said to be captured The nurse is caring for a 32-year-old client admitted with a medical diagnosis of atrial fibrillation, related to "holiday heart" syndrome. A nursing student working with the nurse asks for information about "holiday heart" syndrome. Which is the best response by the nurse? The is the association of heart dysrhythmias, especially atrial fibrillation, with binge drinking Which is not a likely origination point for cardiac dysrhythmias? Bundle of his A client is treated in the intensive care unit (ICU) following an acute myocardial infarction (MI). During the nursing assessment, the client reports shortness of breath and chest pain. In addition, the client’s blood pressure (BP) is 100/60 mm Hg with a heart rate (HR) of 53 bpm, and the electrocardiogram (ECG) tracing shows more P waves than QRS complexes. Which action should the nurse complete first? Initiate transcutaneous pacing LEVEL 7 Which nursing intervention is required to prepare a client with cardiac dysrhythmia for an elective electrical cardioversion? Instruct the client to restrict food and oral intake The nurse receives a telephone call from a client with an implanted pacemaker who reports a pulse of 68 beats per minute, but the pacemaker rate is set at 72 beats per minute. What is the nurse's best response? Please come into the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning The nurse is educating the client about a transvenous pacemaker. What is the best statement to explain why the client will have a transvenous pacemaker? A transvenous pacemaker is used to manage transient bradydysrhythmias like those that occur during acute MIs The nurse is working on a telemetry unit. When the nurse is interpreting a client's heart rhythm, the nurse counts each large block on graph paper as how many seconds? 0.2 The nurse cares for a client following the insertion of a permanent pacemaker. What discharge instruction(s) should the nurse review with the client? Select all that apply. Avoid handheld screening devices in airports, check pulse daily reporting sudden slowing or increase, wear a medical alert noting the presence of a pacemaker The nurse expects to see which of the following characteristics on an ECG strip for a patient who has third-degree AV block? More P waves than QRS complexes A client with heart failure asks the nurse how dobutamine affects the body’s circulation. What is the nurse’s best response? The medication increases the force of the myocardial contraction The nurse participates in the care of a client requiring emergent defibrillation. Arrange the 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 defib to the prescribed voltage, call clear three times ensuring client and environment safety, deliver the prescribed electrical charge Which electrocardiogram (ECG) characteristic is usually seen when a client's serum potassium level is low? U wave A nurse is caring for a client with atrial fibrillation. What procedure would the nurse educate the patient about for termination of the dysrhythmia? Elective cardioversion The nurse would expect which of the following atrial rates to correlate with an idioventricular rhythm? 20 to 40 A client has a heart rate greater than 155 beats/minute and the ECG shows a regular rhythm with a rate of 162 beats/minute. The client is intermittently alert and reports chest pain. P waves cannot be identified. What condition would the nurse expect the physician to diagnose? Supraventricular tachycardia A nurse provides evening care for a client wearing a continuous telemetry monitor. While the nurse is giving the client a back rub, the client ’s monitor alarm sounds and the nurse notes a flat line on the bedside monitor system. What is the nurse’s first response? Assess the client and monitor leads LEVEL 8 A nurse is caring for a client with a history of cardiac disease and type 2 diabetes. The nurse is closely monitoring the client's blood glucose level. Which medication is the client most likely taking? carvedilol The nurse observes an electrocardiogram (ECG) tracing on a cardiac monitor with a pattern in lead II as well as a bizarre, abnormal shape to the QRS complex. The nurse has likely observed which ventricular dysrhythmia? Premature ventricular contraction The nurse knows which heart rhythm occurs when the atrial and ventricular rhythms are both regular, but independent of each other? Third-degree atrioventricular (AV) heart block A 1-minute electrocardiogram (ECG) tracing of a client with a regular heart rate reveals 25 small, square boxes within an RR interval. The nurse correctly identifies the client heart rate as 60bpm A client receives a pacemaker to treat a recurring arrhythmia. When monitoring the cardiac rhythm strip, the nurse observes extra pacemaker spikes that don't precede a beat. Which condition should the nurse suspect? Failure to capture During electrical cardioversion, the defibrillator is set to synchronize with the electrocardiogram (ECG) so that the electrical impulse discharges during ventricular depolarization A client has an irregular heart rate of around 100 beats/minute and a significant pulse deficit. What component of the client's history would produce such symptoms? Atrial fibrillation A nurse is caring for a client who is on a continuous cardiac monitor. When evaluating the client's rhythm strip, the nurse notes that the QRS interval has increased from 0.08 second to 0.14 second. Based on this finding, the nurse should withhold continued administration of which drug? Procainamide The nurse is caring for a client scheduled for a transesophageal echocardiogram with a diagnosis of atrial fibrillation. The client's spouse asks the nurse to explain the purpose of the test. What is the nurse's best response? The test will show any blood clots in the heart, and help us determine if it is safe to do a cardioversion The nurse is admitting a client to a telemetry unit with an atrial dysrhythmia. What symptoms will the nurse further evaluate? Chest pain Two clients in cardiac rehabilitation are discussing the differences between scheduled cardioversion and unexpected defibrillation. Which statement does the nurse note is not correct? Cardioversion uses more electrical energy than defibrillation A patient has a persistent third-degree heart block and has had several periods of syncope. What priority treatment should the nurse anticipate for this patient? Insertion of a pacemaker An operating room nurse is caring for a client who is having a pacemaker implanted. The health care provider has requested a demand mode pacemaker for this client. What is this type of pacemaker? Self-activated A client has had an automatic implanted cardioverter defibrillator (AICD) implanted. The nurse explains the purpose and benefits of the AICD to the client's family. The least likely reason for the client’s AICD implantation is that the client: experiences recurrent episodes of atrial flutter A client with a history of mitral stenosis is admitted to the intensive care unit (ICU) with the abrupt onset of atrial fibrillation. The client’s heart rate ranges from 120 to 140 bpm. The nurse recognizes that interventions are implemented to prevent the development of embolic stroke A client has started to exhibit dangerous PVCs in the cardiac postoperative unit. The client has been given a bolus of lidocaine and is under continuous IV infusion, but serious side effects, including hypotension during administration, could occur. What should the nurse be ready to do? Adjust the IV infusion A client is scheduled for an elective electrical cardioversion for a sustained dysrhythmia lasting for 24 hours. Which intervention is necessary for the nurse to implement prior to the procedure? Administer moderate sedation IV and analgesic medication as prescribed The nurse cares for a 56-year-old client who received an implantable cardioverter defibrillator (ICD) 2 days prior. The client tells the nurse “My wife and I can never have sex again now that I have this ICD.” What is the nurse best response by the nurse? You seem apprehensive about resuming sexual activity The nurse is providing discharge instructions for a client with a newly implanted cardiac defibrillator. What statement made by the client indicates the need for further teaching? I will report if I feel lightheaded and dizzy at my next doctor’s appointment What is the drug of choice for a stable client with ventricular tachycardia? Amiodarone The nurse is preparing to administer adenosine for a patient diagnosed with atrial flutter. How should the nurse administer this medication? The dose is administered rapid IV push Which dysrhythmia is common in older clients? Sinus bradycardia The ECG of a new patient shows a P wave slightly different than normal. The nurse is considering the possibility of premature atrial contractions (PAC). The nurse will ask about which factors when taking this client's history? All options are correct Which of the following does the nurse recognize as the therapeutic goal of radiofrequency catheter ablation for a client with cardiac dysrhythmias? Destruction of errant tissue A client with atrial fibrillation, who does not respond to conventional treatment measures and who is not a candidate for cardioversion, would have what procedure recommended? MAZE procedure The nurse knows that a pacemaker is the treatment of choice for what cardiac dysrhythmia? Complete heart block The nurse is instructing on home care after placement of an automatic implanted cardioverter defibrillator (AICD). Which statement, made by the client, needs clarification by the nurse? I need to stay away from microwaves A nurse should obtain serum levels of which electrolytes in a client with frequent episodes of ventricular tachycardia? Magnesium and potassium The nurse is administering propanolol to a client on a telemetry unit. What will the nurse monitor the client for? Heart block Chap 27 Level 1 A nurse teaches a client with angina pectoris that he or she needs to take up to three sublingual nitroglycerin tablets at 5-minute intervals and immediately notify the health care provider if chest pain doesn't subside within 15 minutes. What symptoms may the client experience after taking the nitroglycerin? Headache, hypotension, dizziness, and flushing 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 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 When the postcardiac surgery client demonstrates restlessness, nausea, weakness, and peaked T waves, the nurse reviews the client's serum electrolytes, anticipating which abnormality? Hyperkalemia Which medication is an antidote to heparin? Protamine sulfate Which complication of cardiac surgery occurs when fluid and clots accumulate in the pericardial sac, which compresses the heart, preventing blood from filling the ventricles? Cardiac tamponade A client is receiving intravenous heparin to prevent blood clots. The order is for heparin 1,200 units per hour. The pharmacy sends 25,000 units of heparin in 500 mL of D5W. At how many milliliters per hour will the nurse infuse this solution? Record your answer using a whole number. 24 What is a modifiable risk factor for the development of atherosclerosis? Consumption of a high-fat diet The nurse is assessing a postoperative patient who had a percutaneous transluminal coronary angioplasty (PTCA). Which possible complications should the nurse monitor for? (Select all that apply.) abrupt closure of the artery, arterial dissection, coronary artery vasospasm A patient in the recovery room after cardiac surgery begins to have extremity paresthesia, peaked T waves, and mental confusion. What type of electrolyte imbalance does the nurse suspect this patient is having? Potassium A client in the emergency department reports squeezing substernal pain that radiates to the left shoulder and jaw. The client 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 To be effective, percutaneous transluminal coronary angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction (MI)? 60 mins A client with a family history of coronary artery disease reports experiencing chest pain and palpitations during and after morning jogs. What would reduce the client’s cardiac risk? Smoking cessation The nurse is admitting a client with an elevated creatine kinase-MB isoenzyme (CK-MB). What is the cause for the elevated isoenzyme? Myocardial necrosis A nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers the client to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? Rehabilitation will help me function as well as I physically can A client reports chest pain and heavy breathing when exercising or when stressed. Which is a priority nursing intervention for the client diagnosed with coronary artery disease? Assess chest pain and administer prescribed drugs and oxygen When the nurse notes that, after cardiac surgery, the client demonstrates low urine output (less than 25 mL/h) with high specific gravity (greater than 1.025), the nurse suspects which condition? Inadequate fluid volume Which is a diagnostic marker for inflammation of vascular endothelium? C-reactive protein (CRP) When a client who has been diagnosed with angina pectoris reports experiencing chest pain more frequently, even at rest, that the period of pain is longer, and that it takes less stress for the pain to occur, the nurse recognizes that the client is describing which type of angina? Unstable LEVEL 2 The client has had biomarkers tested after reporting chest pain. Which diagnostic marker of myocardial infarction remains elevated for as long as 2 weeks? Troponin A client with known coronary artery disease reports intermittent chest pain, usually on exertion. 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 A new surgical patient who has undergone a coronary artery bypass graft (CABG) is receiving opioids for pain control. The nurse must be alert to adverse effects of opioids. Which of the following effects would be important for the nurse to document? hypotension The nurse is administering a calcium channel blocker to a patient who has symptomatic sinus tachycardia at a rate of 132 bpm. What is the anticipated action of the drug for this patient? Decrease the sinoatrial node automaticity The nurse is caring for a client after cardiac surgery. What laboratory result will lead the nurse to suspect possible renal failure? A serum BUN of 70mg/dl The client is prescribed nadolol for hypertension. What is the reason the nurse will teach the client not to stop taking the medication abruptly? The abrupt stop can cause a MI The nurse is explaining the cause of angina pain to a client. What will the nurse say caused the pain? A lack of Oxygen in the heart muscle that causes the death of cells LEVEL 3 A nurse is caring for a client who is exhibiting signs and symptoms characteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment? Assess the clients level of pain and administer prescribed analgescis 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 In the treatment of coronary artery disease (CAD), medications are often ordered to control blood pressure in the client. Which of the following is a primary purpose of using beta-adrenergic blockers in the nursing management of CAD? To decrease workload of the heart The nurse is caring for a client following a coronary artery bypass graft (CABG). The nurse notes persistent oozing of bloody drainage from various puncture sites. The nurse anticipates that the physician will order which medication to neutralize the unfractionated heparin the client received? Protamine sulfate The nurse is caring for a client presenting to the emergency department (ED) reporting chest pain. Which electrocardiographic (ECG) finding would be most concerning to the nurse? ST elevation A client presents to the ED reporting anxiety and chest pain after shoveling heavy snow that morning. The client says that nitroglycerin has not been taken for months but upon experieincing this chest pain did take three nitroglycerin tablets. Although the pain has lessened, the client states, “They did not work all that well.” The client shows the nurse the nitroglycerin bottle; the prescription was filled 12 months ago. The nurse anticipates which order by the physician? Nitroglycerin SL A patient with coronary artery disease (CAD) is having a cardiac catheterization. What indicator is present for the patient to have a coronary artery bypass graft (CABG)? The patient has at least 70% occlusion of a major coronary artery The nurse is caring for a client diagnosed with coronary artery disease (CAD). What condition most commonly results in CAD? Atherosclerosis After percutaneous transluminal coronary angioplasty (PTCA), the nurse confirms that a client is experiencing bleeding from the femoral site. What will be the nurse's initial action? Apply manual pressure at the site of the insertion of the sheath Which medication is given to clients who are diagnosed with angina but are allergic to aspirin? Clopidogrel The nurse is caring for a client with Raynaud’s disease. What is an important instruction for a client who is diagnosed with this disease to prevent an attack? Avoid situations that contribute to ischemic episodes Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty? Withhold anticoagulant therapy A nurse is caring for a client who experienced an MI. The client is ordered to received metoprolol. The nurse understands that this medication has which therapeutic effect? Decreases resting heart rate The nurse is teaching a client about atherosclerosis. The client asks the nurse what the substance causing atherosclerosis is made of. How does the nurse best respond? Fatty deposits in the lumen of arteries LEVEL 4 A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client's care plan, which expected outcome should a nurse include? Client will verbalize the intention to stop smoking A client with chronic arterial occlusive disease undergoes percutaneous transluminal coronary angioplasty (PTCA) for mechanical dilation of the right femoral artery. After the procedure, the client will be prescribed long-term administration of which drug? Aspirin or clopidogrel A client is receiving nitroglycerin ointment to treat angina pectoris. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's response and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin? Blood pressure 84/52mmHG Which term refers to preinfarction angina? Unstable angina A client's lipid profile reveals an LDL level of 122 mg/dL. This is considered a: high LDL level A client comes to the emergency department (ED) complaining of precordial chest pain. In describing the pain, the client describes it as pressure with a sudden onset. What disease process would the nurse suspect in this client? Coronary artery disease The nurse is caring for a client after cardiac surgery. What is the most immediate concern for the nurse? Potassium level of 6mEq/L The nurse is teaching the client about coronary artery damage after an abnormal fasting lipid profile. The client asks the nurse what type of lipid is most troublesome. What is the nurse’s best response? Enhance myocardial oxygenation A client is ordered a nitroglycerine transdermal patch for treatment of CAD and asks the nurse why the patch is removed at bedtime. Which is the best response by the nurse? Removing the patch at night prevents drug tolerance while keeping the benefits Severe chest pain is reported by a client during an acute myocardial infarction. Which of the following is the most appropriate drug for the nurse to administer? Morphine sulfate The nurse is discussing risk factors for developing CAD with a patient in the clinic. Which results would indicate that the patient is not at significant risk for the development of CAD? High density lipoprotein 80mg/dL A client reports midsternal chest pain radiating down his left arm. The nurse notes that the client is restless and slightly diaphoretic, and measures a temperature of 99.6 °F (37.6 °C); a heart rate of 102 beats/minute; regular, slightly labored respirations at 26 breaths/minute; and a blood pressure of 150/90 mm Hg. What assessment is the nurse's highest priority? Acute pain The laboratory values for a client diagnosed with coronary artery disease (CAD) have just come back from the lab. The client's low-density lipoprotein (LDL) level is 112 mg/dL. This nurses recognizes that this value is high A client comes to the emergency department reporting 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 Which s the analgesic of choice for acute myocardial infarction (MI)? Morphine A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which finding requires immediate intervention by the nurse? Altered level of consciousness The nurse is reviewing the results of a total cholesterol level for a client who has been taking simvastatin. What results display the effectiveness of the medication? 160-190 mg/dL LEVEL 5 A client, who has undergone a percutaneous transluminal coronary angioplasty (PTCA), has received discharge instructions. Which statement by the client would indicate the need for further teaching by the nurse? I should expect a low-grade fever and swelling at the site for next week Following a percutaneous coronary intervention (PCI), a client is returned to the nursing unit with large peripheral vascular access sheaths in place. The nurse understands that which method to induce hemostasis after sheath is contraindicated? Application of a sandbag to the area The nurse understands it is important to promote adequate tissue perfusion following cardiac surgery. Which measures should the nurse complete to prevent the development of deep venous thrombosis (DVT) and possible pulmonary embolism (PE)? Select all that apply. Initiate passive exercises, avoid elevating the knees on the bed, apply antiembolism stockings A client had a percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse administer to prevent thrombus formation in the stent? Clopidogrel The nurse is administering oral metoprolol. Where are the receptor sites mainly located? Heart The nurse is assessing a client with suspected postpericardiotomy syndrome after cardiac surgery. What manifestation will alert the nurse to this syndrome? Pericardial friction rub A client diagnosed with a myocardial infarction (MI) is being moved to the rehabilitation unit for further therapy. Which statement reflects a goal of rehabilitation for the client with an MI? improvement in quality of life A client presents to the ED with a myocardial infarction. Prior to administering a prescribed thrombolytic agent, the nurse must determine whether the client has which absolute contraindication to thrombolytic therapy? Prior intracranial hemorrhage When providing discharge instructions for a client who has been prescribed sublingual nitroglycerin for angina, the nurse should plan to include which instructions? See if rest relieves the chest pain before using the nitroglycerin A client admitted to the coronary care unit (CCU) diagnosed with a STEMI is anxious and fearful. Which medication will the nurse administer to relieve the client’s anxiety and decrease cardiac workload? IV morphine LEVEL 6 Heparin therapy is usually considered therapeutic when the client's activated partial thromboplastin time (aPTT) is how many times normal? 2.0-2.5 Which technique is used to surgically revascularize the myocardium? Minimally invasive direct coronary bypass A client asks the clinic nurse what the difference is between arteriosclerosis and atherosclerosis. What is the nurse's best response? Arteriosclerosis is a loss of elasticity, or hardening of the arteries, that happens as we age A client asks the nurse how long to wait after taking nitroglycerin before experiencing pain relief. What is the best answer by the nurse? 3mins The nurse administers propranolol hydrochloride to a patient with a heart rate of 64 beats per minute (bpm). One hour later, the nurse observes the heart rate on the monitor to be 36 bpm. What medication should the nurse prepare to administer that is an antidote for the propranolol? Atropine The nurse is educating a patient diagnosed with angina pectoris about the difference between the pain of angina and a myocardial infarction (MI). How should the nurse describe the pain experienced during an MI? (Select all that apply.) it is substernal in location, it is sudden in onset and prolonged in duration, it is viselike and radiates to the shoulders and arms An older adult is postoperative day one, following a coronary artery bypass graft (CABG). The client's family members express concern to the nurse that the client is uncharacteristically confused. After reporting this change in status to the health care provider, what additional action should the nurse take? Assess for factors that may be causing the client’s delirium LEVEL 7 A client is admitted for treatment of Prinzmetal's angina. When developing this client's care plan, the nurse should keep in mind that this type of angina is a result of what trigger? Coronary artery spasm A nurse reviews a client's medication history before administering a cholinergic blocking agent. Adverse effects of a cholinergic blocking agent may delay absorption of what medication? Nitroglycerin A client who has been diagnosed with Prinzmetal’s angina will present with which symptom? Chest pain that occurs at rest and usually in the middle of the night The nurse recognizes that the treatment for a non-ST-elevation myocardial infarction (NSTEMI) differs from that for a STEMI, in that a STEMI is more frequently treated with percutaneous coronary intervention A middle-aged client presents to the ED reporting severe chest discomfort. Which finding is most indicative of a possible myocardial infarction (MI)? chest discomfort not relieved by rest or nitroglycerin The nurse is assisting with a bronchoscopy at the bedside in a critical care unit. The client experiences a vasovagal response. What should the nurse do next? Check blood pressure LEVEL 8 A client with a myocardial infarction (MI) develops pulmonary crackles and dyspnea. A chest X-ray shows evidence of pulmonary edema. What type of MI did this client have? Anterior Two female nursing assistants approach a nurse on a cardiac step- down unit to report that a client who experienced an acute myocardial infarction made sexual comments to them. How should the nurse intervene? The nurse should explain that the client might have concerns about resuming sexual activity but is afraid to ask The nurse is providing education about angina pectoris to a hospitalized client who is about to be discharged. What instruction does the nurse include about managing this condition? Select all that apply. Balance rest with activity, carry nitro at all times, stop smoking Which client with a venous stasis ulcer is a candidate for topical hyperbaric oxygen therapy? A client with a chromic, nonhealing skin lesion Understanding atherosclerosis, the nurse identifies which of the following to be both a risk factor for the development of the disorder and an outcome? hypertension The charge nurse was discussing with the nursing student that studies have been published that suggest inflammation increases the risk of heart disease. Which modifiable factor would the nursing student target in teaching clients about prevention of inflammation that can lead to atherosclerosis? Addressing obesity The nurse is caring for a client experiencing an acute MI (STEMI). The nurse anticipates the physician will prescribe alteplase. Before administering this medication, which question is mostimportant for the nurse to ask the client? What time did your chest pain start today? The nurse is caring for a ventilated client after coronary artery bypass graft surgery. What are the criterions for extubation for the client? Select all that apply. Breathing without assistance of the ventilator, adequate cough and gag reflex, acceptable arterial blood gas values An electrocardiogram (ECG) taken during a routine checkup reveals that a client has had a silent myocardial infarction. Changes in which leads of a 12-lead ECG indicate damage to the left ventricular septal region? Leads V3 and V4 A client has just arrived in the ER with a possible myocardial infarction (MI). The electrocardiogram (ECG) should be obtained within which time frame of arrival to the ER? 10mins The nurse is reevaluating a client 2 hours after a percutaneous transluminal coronary angioplasty (PTCA) procedure. Which assessment finding may indicate the client is experiencing a complication of the procedure? Urine output of 40mL A client has had a 12-lead ECG completed as part of an annual physical examination. The nurse notes an abnormal Q wave on an otherwise unremarkable ECG. The nurse recognizes that this finding indicates an old MI A patient has had cardiac surgery and is being monitored in the intensive care unit (ICU). What complication should the nurse monitor for that is associated with an alteration in preload? Cardiac tamponade The nurse is teaching a client diagnosed with coronary artery disease about nitroglycerin. What is the cardiac premise behind administration of nitrates? Preload is reduced A client who is resting quietly reports chest pain to the nurse. The cardiac monitor indicates the presence of reversible ST-segment elevation. What type of angina is the client experiencing? Variant angina The client is asking the nurse about heart-healthy food choices for lunch. What are foods that are heart healthy? Select all that apply. Soy yogurt, broiled trout, blueberries Which method to induce hemostasis after sheath removal after percutaneous transluminal coronary angioplasty (PTCA) is most effective? Application of a vascular closure device such as angio-seal or Vasoseal Following a percutaneous transluminal coronary angioplasty, a client is monitored in the postprocedure unit. The client's heparin infusion was stopped 2 hours earlier. There is no evidence of bleeding or hematoma at the insertion site, and the pressure device is removed. With regards to partial thromboplastin time (PTT), when should the nurse plan to remove the femoral sheath? 50seconds or less A client was transferring a load of firewood in the morning and experienced a heaviness in the chest and dyspnea. The client arrives in the emergency department four hours after the heaviness and the health care provider diagnoses an anterior myocardial infarction (MI). What orders will the nurse anticipate? Sublingual nitroglycerin, tissue plasminogen activator (tPA) and telemetry The nurse is caring for a client who was admitted to the telemetry unit with a diagnosis of "rule/out acute MI." The client's chest pain began 3 hours earlier. Which laboratory test would be most helpful in confirming the diagnosis of a current MI? creatinine kinase-myoglobin (CK-MB) level A client is scheduled for a percutaneous transluminal coronary angioplasty (PTCA) immediately following confirmed diagnosis of acute myocardial infarction. The client is overtly anxious and crying. Which response by the nurse is most appropriate? Tell me what concerns you most Following cardiac surgery, the nurse assesses the client for any common complication of hypovolemia. What significant indication of a complication should the nurse monitor? Pulmonary artery wedge pressure (PAWP) of 6mmHg A client with CAD has been prescribed a transdermal nitroglycerin patch. What instructions should the nurse provide to the client? Select all that apply. Store the patch in its original container when not in use, remove the transdermal patch at night and reapply in the morning A nurse reviews an ECG strip for a client who is admitted with symptoms of an acute MI. The nurse should recognize what classic ECG changes that occur with an MI? Select all that apply. T-wave hyperactivity and inversions, abnormal Q-waves, ST- segment elevation A nurse completed a client physical examination for an insurance company. The nurse determined the client has increased blood pressure, increased blood glucose, levels and obesity. What condition for coronary artery disease does the nurse consider next? Metabolic syndrome A nurse is teaching about risk factors that increase the probability of heart disease to a community group. Which risk factors will the nurse include in the discussion? Select all that apply. African-american descent, family hx of CAD, age greater than 45yrs for men, elevated C- reactive protein A client is being evaluated for coronary artery disease (CAD) and is scheduled for an electron beam computed tomography (EBCT). The nurse understands that the primary advantage of this radiologic test is which of the following? Quantifies calcified plaque The nurse is working a cardiac care unit with a client on a diltezem intravenous drip for atrial fibrillation. What are electrocardiogram (ECG) changes that suggest the client is responding to the treatment? Select all that apply. I can take nitroglycerin before sex so I wont develop chest pain While receiving a heparin infusion to treat deep vein thrombosis, a client reports bleeding in the gums when brushing teeth. What should the nurse do first? Notify the health care provider A client's elevated cholesterol levels are being managed with atorvastatin daily. What is a common side effect the nurse will teach the client that will require monitoring? Increased liver enzymes The nurse is teaching a client with suspected acute myocardial infarction about serial isoenzyme testing. When is it best to have isoenzyme creatinine kinase of myocardial muscle (CK-MB) tested? 4- 6hrs after pain Show Less