Summary PrepU Chapter 22 &23 Multidimensional Care III/ MDC 3

PrepU- Chapter 23 & 22 Cardiac 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 nurse records a client's history and discovers several risk factors for coronary artery disease (CAD). Which cardiac risk factors can the client control? - Diabetes, hypercholesterolemia, and hypertension 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 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 Which is a diagnostic marker for inflammation of vascular endothelium? - CRP A nurse is caring for a client in the cardiovascular intensive care unit following a coronary artery bypass graft. Which clinical finding requires immediate intervention by the nurse? - Central venous pressure of 1 A client asks the nurse how long to wait after taking nitroglycerin before experiencing pain relief. What is the best answer by the nurse? - 5 minWhen 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 when I was mowing the lawn 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 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 client's level of pain and administer prescribed analgesics. A client with chest pain arrives in the emergency department and receives nitroglycerin, morphine, oxygen, and aspirin. The health care provider diagnoses acute coronary syndrome. When the client arrives on the unit, vital signs are stable and the client does not report any pain. In addition to the medications already given, which medication does the nurse expect the health care provider to order? - Carvedilol 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 The nurse is caring for a client after cardiac surgery. What is the most immediate concern for the nurse? - Potassium 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? - Decreases the SA node automaticityThe client has had biomarkers tested after reporting chest pain. Which diagnostic marker of myocardial infarction remains elevated for as long as 2 weeks? - Troponin The nurse is caring for a client with Raynaud syndrome. What is an important instruction for a client who is diagnosed with this disease to prevent an attack? - Avoid situations that trigger 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 min A client presents to the emergency room with characteristics of atherosclerosis. What characteristics would the client display? - Fatty deposits in lumen of arteries 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 Explanation: The assessment of pain takes highest priority because it increases the client's pulse and blood pressure. During the acute phase of an MI, low-grade fever is an expected result of the body's response to myocardial tissue necrosis. The client's blood pressure and heart rate do not suggest a decreased cardiac output. Anxiety may be an important assessment, but addressing acute pain (the priority concern) may alleviate the client's anxiety The client is prescribed nadolol for hypertension. What is the reason the nurse will teach the client not to stop taking the medication abruptly? - Abrupt stop can cause MI The nurse is admitting a client with an elevated creatine kinase-MB isoenzyme (CK-MB). What is the cause for the elevated isoenzyme? - Myocardial necrosisThe nurse has completed a teaching session on self-administration of sublingual nitroglycerin. Which client statement indicates that the teaching has been effective? - I can take it before sex so I wont develop chest pain The nurse is caring for a client with coronary artery disease. What is the nurse's priority goal for the client? - Enhance myocardial oxygenation The nurse provides care to a menopausal client, who states, “I read a news article that says I am at risk for coronary vascular disease due to inflammation.” Which method should the nurse suggest to the client to aid in the prevention of inflammation that can lead to atherosclerosis? - Addressing obesity Which is the most important postoperative assessment parameter for a client recovering from cardiac surgery? - Inadequate tissue perfusion The nurse is caring for a client diagnosed with coronary artery disease (CAD). What condition most commonly results in CAD? - Atherosclerosis 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 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? - 10 min A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which finding requires immediate intervention by the nurse? - Altered LOCA client reports chest pain that occurs when playing tennis but resolves when sitting down. The nurse knows these symptoms are common for which type of angina. - Stable A client has been recently placed on nitroglycerin. Which instruction by the nurse should be included in the client's teaching plan? - Instruct pt on side effects 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. The nurse recognizes that this value is - Above optimal range 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 BP A client comes to the emergency department (ED) reporting 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? - CAD The client asks the nurse to explain the difference between arteriosclerosis and atherosclerosis. Which is the best explanation the nurse can give to the client?  “Arteriosclerosis is a loss of elasticity of the arteries that accompanies the aging process, whereas atherosclerosis is a condition in which the arteries fill with plaque.” 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? - Verbalize intention to stop smoking 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 nightA triage team is assessing a client to determine if reported chest pain is a manifestation of angina pectoris or an MI. The nurse knows that a primary distinction of angina pain is? - Relieved by rest and nitro 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 the next week.” Which of the following is inconsistent as a condition related to metabolic syndrome? - Hypotension 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 HR 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." Which medication is given to clients who are diagnosed with angina but are allergic to aspirin? - Plavix A client was chopping firewood 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 telemetryA 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 The nurse is assessing a client with severe angina pectoris and electrocardiogram changes in the emergency room. What is the most important cardiac marker for the client? - Troponin 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 40 mL 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. - Adequate cough and gag reflex - Acceptable ABG values - Breathing without assistance of ventilator 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? - 50 sec Creatine kinase-MB isoenzyme (CK-MB) can increase as a result of: - Myocardial necrosis 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.) - Substernal in location - Sudden and prolonged in durationViselike and radiates to shoulders and arms The nurse recognizes that the treatment for a non-STelevation myocardial infarction (NSTEMI) differs from that for a STEMI, in that a STEMI is more frequently treated with - percutaneous coronary intervention (PCI). When the patient diagnosed with angina pectoris complains that he is experiencing chest pain more frequently even at rest, the period of pain is longer, and it takes less stress for the pain to occur, the nurse recognizes that the patient is describing which type of angina? - Unstable Which of the following discharge instructions for self-care should the nurse provide to a patient who has undergone a percutaneous transluminal coronary angioplasty (PTCA) procedure? - Monitor the site for bleeding or hematoma. A client with suspected acute myocardial infarction is admitted to the coronary care unit. To help confirm the diagnosis, the physician orders serial enzyme tests. Increased serum levels of the isoenzyme creatinine kinase of myocardial muscle (CK-MB), found only in cardiac muscle, can be detected how soon after the onset of chest pain? - 4-6 hours A female client returns for a follow-up visit to the cardiologist 4 days after a trip to the ED for sudden shortness of breath and abdominal pain. The nurse realizes the client had a myocardial infarction because the results from the blood work drawn in the hospital shows: - Elevated troponin levels You are presenting a workshop at the senior citizens center about how the changes of aging predispose clients to vascular occlusive disorders. What would you name as the most common cause of peripheral arterial problems in the older adult? - Atherosclerosis A client has a blockage in the proximal portion of a coronary artery. After learning about treatment options, the client decides to undergo percutaneous transluminal coronary angioplasty (PTCA). During this procedure, the nurse expects to administer an - anticoagulant A nurse is caring for a patient in the cardiovascular intensive care unit (CVICU) following a coronary artery bypass graft (CABG). Which of the following clinical findings requires immediate intervention by the nurse?- CVP reading: 1 mmHg - 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 should the nurse do? - Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin. Which of the following is also termed preinfarction angina? - Unstable angina Which of the following would be inconsistent as criterion of extubation in the patient who has undergone a coronary artery bypass graft (CABG)? - Inability to speak 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. 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-  is the medication of choice in treating symptomatic second-degree heart block. The client may need to be sent to the cardiac catheterization lab for a temporary pacemaker, but atropine should be tried first. Which is not a likely origination point for cardiac arrhythmias?  bundle of HisA 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. The nurse is providing discharge instructions to a client after a permanent pacemaker insertion. Which safety precaution will the nurse communicate to the client?  Avoid undergoing magnetic resonance imaging (MRI).  (Airport metal detectors don't harm pacemakers) The nurse documents that a client is having a normal sinus rhythm. What characteristics of this rhythm has the nurse assessed?  The sinoatrial (SA) node initiates the impulse. 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 intravenously The nurse witnesses a client experiencing ventricular fibrillation. What is the nurse's priority action?  defibrillation The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block?  Delayed conduction, producing a prolonged PR interval The nurse is providing teaching to a client with an implanted cardiac device. Which client statement indicates that teaching has been effective? “I will not place my cell phone in my chest pocket.” 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- Demand (synchronous) mode pacemakers self-activate when the client's pulse falls below a certain level. A fixed-rate pacemaker is asynchronous and permanent. 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 is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker?  Pacer rate- After a permanent pacemaker is inserted, the patient’s heart rate and rhythm are monitored by ECG. The nurse assesses a client with a heart rate of 120 beats per minute. What are the known causes of sinus tachycardia?  hypovolemia The client has just been diagnosed with a arrhythmia. The client asks the nurse to explain normal sinus rhythm. What would the nurse explain is the characteristic of normal sinus rhythm?  The sinoatrial (SA) node initiates the impulse. A client is diagnosed with an arrhythmia at a rate slower than 60 beats/minute with a regular interval between 0.12 and 0.20 seconds. What type of arrhythmia does the client have?  sinus bradycardia 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 A client's Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minute. What other conditions can cause this response in a healthy heart?  All options are correct. 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. The nurse is monitoring a patient in the post anesthesia 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 The nurse is caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client?  Fluttering A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching?  "I'll keep a log of each time my ICD discharges." The nurse working in the emergency department places a client in anaphylactic shock on a cardiac monitor and sees the cardiac rhythm shown. Which dysrythmia should the nurse document?  ventricular tachycardia 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.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 with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast, with wide QRS complexes." 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." 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 A nurse has provided discharge instructions to a client who received an implantable cardioverter defibrillator (ICD). Which statement, made by the client, indicates the need for further teaching?  “I need to take a cardiopulmonary resuscitation (CPR) class now that I have an ICD.”- the client does not need to take a CPR class. However, it is recommended that the family members and friends of a client who has an ICD learn CPR 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- This client is in need of antidysrhythmic medication, which is the priority intervention. The staff educator is teaching a class in arrhythmias. What statement is correct for defibrillation?  It is used to eliminate ventricular arrhythmias. 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." 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 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 arrhythmias To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform?  P wave A nurse provides morning care for a client in the intensive care unit (ICU). Suddenly, the bedside monitor shows ventricular fibrillation and the client becomes unresponsive. After calling for assistance, what action should the nurse take next?  Begin cardiopulmonary resuscitation 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 The nurse recognizes which as being true of cardioversion?  Defibrillator should be set to deliver a shock during the QRS complex. 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." 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."A client has a medical diagnosis of an advanced first-degree atrioventricular block and is symptomatic. What initial treatment will the nurse be prepared to complete?  administer an IV bolus of atropine A client is admitted to the cardiac care unit for an electrophysiology (EP) study. What goal should guide the planning and execution of the client's care?  Diagnose the dysrhythmia. 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 A client in the emergency department reports squeezing substernal pain that radiates to the left shoulder and jaw. The client also reports nausea, diaphoresis, and shortness of breath. What is the nurse's priority action?  Administer oxygen, attach a cardiac monitor, take vital signs, and alert the cardiac catheterization team.  Cardiac chest pain is caused by myocardial ischemia. the nurse should administer supplemental oxygen to increase the myocardial oxygen supply, attach a cardiac monitor to help detect lifethreatening arrhythmias, and take vital signs to ensure that the client isn't hypotensive before giving sublingual nitroglycerin. 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 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 to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning." 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.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 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 licensed practical nurse is setting up the room for a client arriving at the emergency department with ventricular arrhythmias. The nurse is most correct to place which of the following in the room for treatment?  A defibrillator- clients with ventricular dysrhythmias are at a high risk for fatal heart dysrhythmia and death A client has had a pacemaker implanted and the nurse will begin client education upon the client becoming alert. Which post implantation instructions must be provided to the client with a permanent pacemaker?  Avoid sources of electrical interference. 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 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- Severe muscle pain is an adverse effect of statins, but it does not require monitoring