Cardiac Disorders CARDIO_PREP_U MDC 3 CHAPTER 26 EXAM - CARDIOVASCULAR AND HEMATOLOGY

CHAPTER 26 A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching? Correct response:  "I'll keep a log of each time my ICD discharges." 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? Correct response:  "This test will show any blood clots in the heart, and help us determine if it is safe to do a cardioversion." 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 Correct response: multiply by 10  90 bpm. 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 Correct response:  normal sinus rhythm. 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? Correct response:  Delayed conduction, producing a prolonged PR interval A client is diagnosed with a dysrhythmia at a rate slower than 60 beats/minute. What type of dysrhythmia does the client have? Correct response:  sinus bradycardiaA 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? Correct response:  Atrial flutter The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker? Correct response:  Pacer rate A patient has had several episodes of recurrent tachydysrhythmias over the last 5 months and medication therapy has not been effective. What procedure should the nurse prepare the patient for? Correct response:  Catheter ablation therapy 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? Correct response:  0.12 and 0.2 seconds. The nurse documents that a client is having a normal sinus rhythm. What characteristics of this rhythm has the nurse assessed? Correct response:  The sinoatrial (SA) node initiates the impulse. The nurse is caring for clients on a telemetry unit. Which nursing consideration best represents concerns of altered rhythmic patterns of the heart? Correct response:  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? Correct response: The registered nurse administering atropine sulfate intravenously 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? Correct response:  “Spike” on the rhythm strip 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 Correct response:  avoid caffeinated beverages. Which ECG waveform characterizes conduction of an electrical impulse through the left ventricle? Correct response:  QRS complex 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? Correct response:  "You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks." The nurse is caring for a client who has a suspected dysrhythmia. What most appropriate intervention should the nurse use to help detect dysrhythmias? Correct response:  Monitor cardiac rhythm continuously. 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?  elevated temperature  shock  strenuous exercise Correct response: All options are correct. A patient with hypertension has a newly diagnosed atrial fibrillation. What medication does the nurse anticipate administering to prevent the complication of atrial thrombi? Correct response:  Warfarin 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? Correct response:  "The small box will transmit the heart rhythm to the central monitor all the time." The nurse is assessing a client with symptomatic bradycardia. What medication does the nurse anticipate will be ordered by the healthcare provider to treat the bradycardia? Correct response:  Atropine 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? Correct response:  Atrial depolarization The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block? Correct response:  Delayed conduction, producing a prolonged PR interval To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform? Correct response:  P wave The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation? Correct response:  It is used to eliminate ventricular dysrhythmias.The nurse knows that what PR interval presents a first-degree heart block? Correct response:  0.24 seconds 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? Correct response:  A client with atrial dysrhythmias The client asks the nurse to explain what is meant by a ventricular bigeminy cardiac rhythm. What is the best response by the nurse? Correct response:  "The rhythm has a normal beat, then a premature beat pattern." 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? Correct response:  Clients with recurrent life-threatening tachydysrhythmias The nurse identifies which of the following as a potential cause of premature ventricular complexes (PVCs)? Correct response:  Hypokalemia 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? Correct response:  Ventricular fibrillation The nurse reads an athletic client's electrocardigram. What finding will be consistent with a sinus bradycardia? Correct response:  Heart rate of 42 beats per minute (bpm).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? Correct response:  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? Correct response:  Monitor vital signs and cardiac rhythm 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? Correct response:  Double-check the monitoring equipment. 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? Correct response:  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? Correct response:  Document the findings and continue to monitor the client 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? Correct response:  "Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning." 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? Correct response: Elective electrical cardioversion The nurse knows that electrocardiogram (ECG) characteristics of atrial fibrillation include what? Correct response:  Atrial rate of 300 to 400 The nurse is caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client? Correct response:  Fluttering 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? Correct response:  atropine sulfate Two nursing students are reading EKG strips. One of the students asks the instructor what the PR interval represents. The correct response should be which of the following? Correct response:  "It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." 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? Correct response:  Question the client about alcohol and illicit drug use. 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. Correct response:  P wave  P-R interval  T waveWhich diagnostic study best evaluates different medications ability to restore normal heart rhythm? Correct response:  Electrophysiology study 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? Correct response:  Atrial flutter 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? Correct response:  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? Correct response:  A defibrillator 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? Correct response:  Alerting the healthcare provider of the third-degree heart block Which is not a likely origination point for cardiac dysrhythmias? Correct response:  bundle of His The nurse is preparing to defibrillate a client with no breathing or pulse. Which nursing action precedes the nurse pressing the discharge button? Correct response:  Shouts, “All clear”A client’s electrocardiogram (ECG) tracing reveals a atrial rate between 250 and 400, with sawtoothed P waves. The nurse correctly identifies this dysrhythmia as Correct response:  Atrial flutter 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? Correct response:  internal cardioverter defibrillator insertion Which nursing intervention is required to prepare a client with cardiac dysrhythmia for an elective electrical cardioversion? Correct response:  Instruct the client to restrict food and oral intake 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? Correct response:  Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers 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? Correct response:  Elective electrical cardioversion The licensed practical nurse is monitoring the waveform pattern on the cardiac monitor ofthe 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? Correct response:  BigeminyWhen the nurse observes an electrocardiogram (ECG) tracing on a cardiac monitor with a pattern in lead II and observes a bizarre, abnormal shape to the QRS complex, the nurse has likely observed which of the following ventricular dysrhythmias? Correct response:  Premature ventricular contraction (PVC) 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? Correct response:  During the procedure, the dysrhythmia will be reproduced under controlled conditions. 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? Correct response:  supraventricular tachycardia The nurse is caring for a client with atrial fibrillation. What procedure would be recommended if drug therapies did not control the dysrhythmia? Correct response:  Elective cardioversion The nurse is attempting to determine the ventricular rate and rhythm of a patient’s telemetry strip. What should the nurse examine to determine this part of the analysis? Correct response:  RR interval A nurse should obtain serum levels of which electrolytes in a client with frequent episodes of ventricular tachycardia? Correct response:  Magnesium and potassium Which rhythm is also termed a ventricular escape rhythm? Correct response:  Idioventricular rhythmThe nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. Which question by the client indicates a need for clarification? Correct response:  "I should ask for a handheld device search when I go through airport security." 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? Correct response:  “I need to stay away from microwaves.” These are the answer choices for this question above. (they reflect correct statements) “I need to notify my cardiologist if I feel frequent kicks to the chest.” “I can continue to work with my power tools.” “I should opt for a hand search at the airport instead of metal detector scan.” A client with heart failure asks the nurse how dobutamine affects the body’s circulation. What is the nurse’s best response?. Correct response:  The medication increases the force of the myocardial contraction. What is the drug of choice for a stable client with ventricular tachycardia? Correct response:  Amiodarone 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? Correct response:  0.2 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? Correct response:  “I need to take a cardiopulmonary resuscitation (CPR) class now that I have an ICD.”Correct Responses within question above “I will document the date and time if my ICD fires.” “I can play golf with my son in about 2 or 3 weeks.” “I should tell close friends and family members that I have an ICD.” 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? Correct response:  Alerting the healthcare provider of the third-degree heart block The nurse is assessing a client with mitral regurgitation. The nurse expects to note what finding in this client? Correct response:  Dyspnea, fatigue, and weakness Two clients in cardiac rehabilitation are discussing the differences between scheduled cardioversion and unexpected defibrillation. Which statement does the nurse note is not correct? Correct response:  Cardioversion uses more electrical energy than defibrillation. 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? Correct response:  Administer moderate sedation IV and analgesic medication as prescribed The nurse is defibrillating a patient in ventricular fibrillation with paddles on a monophasic defibrillator. How much paddle pressure should the nurse apply when defibrillating? Correct response:  20 to 25 lbs During electrical cardioversion, the defibrillator is set to synchronize with the electrocardiogram (ECG) so that the electrical impulse discharges during Correct response:  ventricular depolarization.The nurse would expect which of the following atrial rates to correlate with an idioventricular rhythm? Correct response:  20 to 40 The nurse analyzes the electrocardiogram (ECG) strip of a stable patient admitted to the telemetry unit. The client’s ECG strip demonstrates PR intervals that measure 0.24 seconds. What is the nurse’s most appropriate action? Correct response:  Document the findings and continue to monitor the patient 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? Correct response:  Atenolol Stimulate sympathetic nervous system: Aminophylline, Atropine, Epinephrine The nurse receives a client from the post anesthesia unit with a new onset of sinus tachycardia and a heart rate of 118 beats per minute. To which reasons does the nurse relate the increased heart rate? Select all that apply. Correct response:  Fever  Blood loss  Anxiety All answer choices: Fever, Blood loss, Sleep, Hypoglycemia, Anxiety The nurse knows which heart rhythm occurs when the atrial and ventricular rhythms are both regular, but independent of each other? Correct response:  Third-degree atrioventricular (AV) heart block 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: Correct response:  experiences recurrent episodes of atrial flutter.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? Correct response:  Adjust the IV infusion. 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? Correct response:  The need to have regular blood levels drawn 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 Correct response:  embolic stroke. 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? Correct response:  “You seem apprehensive about resuming sexual activity.” The nurse assesses a client returning from the post anesthesia unit with a new onset of sinus tachycardia with a heart rate of 138 beats per minute and a blood pressure of 128/80mmHg after elevating the head of the bed. What intervention does the nurse consider? Correct response:  Evaluating laboratory values The nurse knows that synchronization of cardioversion prevents the discharge from occurring during the vulnerable period of which of the following? Correct response:  Ventricular repolarizationThe nurse is caring for a client with a dysrhythmia. While assessing the data in the history of the chart, the nurse anticipates the cause of the dysrhythmia to be which of the following? Correct response:  Ischemic heart disease The nurse expects to see which of the following characteristics on an ECG strip for a patient who has third-degree AV block? Correct response:  More P waves than QRS complexes The nurse is speaking with a client admitted with a dysrhythmia. The client asks the nurse to explain the “F waves” on the electrocardiogram. What is the nurse’s best response? Correct response:  “The F waves are flutter waves representing atrial activity.” 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? Correct response:  Carvedilol Undersensing occurs as a pacemaker malfunctions. The nurse understands undersensing occurs as a result of which event? Correct response:  Pacing spike occurs at the preset level A nurse is caring for a client who has premature ventricular contractions. What sign would the nurse assess in this client? Correct response:  Fluttering/heart skipping Which of the following medications does the nurse anticipate administering to a client preparing for cardioversion? Correct response:  DiazepamThe nurse cares for a client who has developed junctional tachycardia with a heart rate (HR) of 80 bpm. Which action should the nurse complete? Correct response:  Request a digoxin level be ordered 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 Correct response:  sinus dysrhythmia. The nurse is administering propranolol to a client on a telemetry unit. What will the nurse monitor the client for? Correct response:  heart block A client is prescribed quinine for treatment of moderate depression of depolarization. Which sign indicates the drugs' effectiveness in the client's treatment? Correct response:  Decrease in cardiac contractility 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 a rate of 150 bpm, with no discernible P waves. What does the nurse determine this rhythm to be? Correct response:  Atrial fibrillation 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? Correct response:  Third degree 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? Correct response: "This is the association of heart dysrhythmias, especially atrial fibrillation, with binge drinking." 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? Correct response:  Insertion of a pacemaker What is the treatment of choice for ventricular fibrillation? Correct response:  Immediate bystander CPR 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? Correct response:  Failure to capture The nurse checks the synchronizer switch before using a defibrillator to terminate ventricular fibrillation for what important reason? Correct response:  The defibrillator won't deliver a shock if the synchronizer switch is turned on. 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? Correct response:  "We will be getting rid of our microwave oven so it will not affect my pacemaker." The nurse is admitting a client to a telemetry unit with an atrial dysrhythmia. What symptoms will the nurse further evaluate? Correct response:  chest pain The nurse is providing discharge teaching with a client about pacemaker surveillance. Which client statement indicates a need for further teaching? Correct response: “I will take acetaminophen prior to the appointment to lessen the interrogation pain.” Elective cardioversion is similar to defibrillation except that the electrical stimulation waits to discharge until an R wave appears. The nurse knows elective cardioversion prevents what? Correct response:  Disrupting the heart during the critical period of ventricular repolarization. The nurse and student nurse are observing a cardioversion procedure completed by a physician. At which time is the nurse most correct to identify to the student when the electrical current will be initiated? Correct response:  During ventricular depolarization 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? Correct response:  "I will report if I feel lightheaded and dizzy at my next doctor’s appointment.” 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? Correct response:  Procainamide Explanation: Procainamide may cause an increased QRS complexes and QT intervals. If the QRS duration increases by more than 50%, then the nurse should withhold the drug and notify the physician of her finding. Metoprolol may cause increased PR interval and bradycardia. Propafenone and verapamil may cause bradycardia and atrioventricular blocks. A home care nurse is visiting a left-handed client who has an implantable cardioverterdefibrillator (ICD) implanted in the left chest. The client is planning to go rifle hunting. How should the nurse respond? Correct response:  "You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site."Explanation: The recoil from the rifle can damage the ICD, so the client should be warned against shooting a rifle with the left hand. Close proximity to a rifle won't cause the ICD to fire inadvertently. The client shouldn't take an extra dose of an antiarrhythmic. Which dysrhythmia is common in older clients? Correct response:  Sinus bradycardia Explanation: Sinus bradycardia is a common dysrhythmia in older clients. Sinus tachycardia, atrial fibrillation, and ventricular tachycardia are not common dysrhythmias in older clients. 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? Correct response:  Premature ventricular contraction Explanation: A premature ventricular contraction (PVC) is an impulse that starts in a ventricle before the next normal sinus impulse. Ventricular bigeminy is a rhythm in which every other complex is a PVC. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute. Ventricular fibrillation is a rapid but disorganized ventricular rhythm that causes ineffective quivering of the ventricles. The client has been prescribed procainamide for a dysrhythmia. Which medication side effect will the nurse teach the client to watch for? Correct response:  Feeling tired Explanation: The side effects of procainamide hydrochloride can include hypotension, GI upset, and feelings of tiredness. Procainamide does not cause hypertension, tachycardia, or a change in mental status. The nurse recognizes that Premature ventricular contractions (PVCs) are considered precursors of ventricular tachycardia (VT) when they: Correct response:  occur at a rate of more than six per minuteExplanation: When PVCs occur at a rate of more than six per minute, they indicate increasing ventricular irritability and are considered forerunners of VT. PVCs are dangerous when they occur on the T wave. PVCs are dangerous when they are multifocal (have different shapes). A PVC that is paired with a normal beat is termed bigeminy. 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? Correct response:  Heparin Explanation: Heparin is generally prescribed initially if the dysrhythmia persists longer than 48 hours. 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. Correct response:  Avoid handheld screening devices in airports  Check pulse daily, reporting sudden slowing or increase  Wear a medical alert, noting the presence of a pacemaker Explanation: Handheld screening devices used in airports may interfere with the pacemaker. Patients should be advised to ask security personnel to perform a hand search instead of using the handheld screening device. With a permanent pacemaker, the client should be instructed initially to restrict activity on the side of implantation. Clients also should be educated to perform a pulse check daily and to wear or carry medical identification to alert personnel to the presence of the pacemaker. Client should walk through antitheft devices quickly and avoid standing in or near these devices. Client can safely use microwave ovens and electronic tools. A 26-year-old client, who has been diagnosed with paroxysmal supraventricular tachycardia (PSVT), is treated in the emergency department. The client is experiencing occasional runs of PSVT lasting up to several minutes at a time. During these episodes, the client becomes lightheaded but does not lose consciousness. Which maneuver(s) may be used to interrupt the client’s atrioventricular nodal reentry tachycardia (AVNRT)? Select all that apply. Correct response:  Stimulating the client’s gag reflex  Placing the client’s face in cold water  Performing carotid massageExplanation: The following vagal maneuvers can be used to interrupt atrioventricular nodal reentry tachycardia (AVNRT): stimulating the client’s gag reflex, having the client hold the breath, cough, bear down, placing the face in cold water, or performing carotid massage. These measures elicit a vagal response, which will slow AV conduction time and help restore a regular rhythm. Because of the risk of a cerebral embolic event, carotid massage is contraindicated in clients with carotid bruits. If the vagal maneuvers are ineffective, the client may receive a bolus of adenosine to correct the rhythm; this is nearly 100% effective in terminating AVNRT. Overexertion and deep inspirations are measures that could precipitate supraventricular tachycardia (SVT). 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? Correct response:  Initiate transcutaneous pacing Explanation: The client is experiencing a third-degree heart block. Transcutaneous pacing should be implemented first. A permanent pacemaker may be indicated if the block continues. Defibrillation is not indicated; third-degree heart block does not respond to atropine; a 12-lead ECG may be obtained, but is not completed first. The nurse understands that asystole can be caused by several conditions. Select all that apply. Correct response:  Hypoxia  Hypovolemia  Hypothermia  Acidosis Explanation: Ventricular asystole is treated the same as pulseless electrical activity (PEA), focusing on high-quality cardiopulmonary resuscitation (CPR) with minimal interruptions and identifying underlying and contributing factors. The key to successful treatment is a rapid assessment to identify a possible cause, which is known as the “Hs and Ts”: hypoxia, hypovolemia, hydrogen ion (acid/base imbalance), hypo- or hyperglycemia, hypo- or hyperkalemia, hyperthermia, trauma, toxins, tamponade (cardiac), tension pneumothorax, or thrombus (coronary or pulmonary). The nurse explains to the patient with PACs that there are many causes, some of which are modifiable. Select all that apply.Correct response:  Hypoxemia  Atrial ischemia  Alcohol  Anxiety Explanation: All of these causes stimulate or increase electrical impulses in the heart except for hyperkalemia. The nurse receives a client from the postanesthesia unit with a new onset of sinus tachycardia and a heart rate of 118 beats per minute. To which reasons does the nurse relate the increased heart rate? Select all that apply. Correct response:  Fever  Blood loss  Anxiety Explanation: Fever, blood loss, and anxiety can be related to tachycardia. Sleep and hypoglycemia are contributing factors to bradycardia. 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. Correct response:  Apply the multifunction conductor pads to the client’s chest.  Turn on the defibrillator and place it in “not sync” mode.  Charge the defibrillator to the prescribed voltage.  Call “clear” three times ensuring client and environmental safety.  Deliver the prescribed electrical charge. Explanation: The nurse should: 1. Apply multifunction conductor pads or paddles with a conducting medium between the paddles and the skin in the proper locations. 2. Turn on the defibrillator in "not-sync" mode (most machines default to this setting). 3. Charge the device to the prescribed voltage. When using a manual discharge device, it must not be charged until ready to shock. 4. Call "clear" three times while visually checking to be sure the nurse and others are not touching the client, bed, or equipment.5. Deliver the charge. Which electrocardiogram (ECG) characteristic is usually seen when a client's serum potassium level is low? Correct response:  U wave Explanation: The U wave is an ECG waveform characteristic that may reflect Purkinje fiber repolarization. It is usually seen when a client's serum potassium level is low. The T wave is an ECG characteristic reflecting repolarization of the ventricles. It may become tall or "peaked" if a client's serum potassium level is high. The P wave is an ECG characteristic reflecting conduction of an electrical impulse through the atria. The QT interval is an ECG characteristic reflecting the time from ventricular depolarization to repolarization. Which term is used to describe a tachycardia characterized by abrupt onset, abrupt cessation, and a QRS of normal duration? Correct response:  Paroxysmal atrial tachycardia Explanation: Paroxysmal atrial tachycardia (PAT) is often caused by a conduction problem in the AV node and is now called AV nodal reentry tachycardia. Sinus tachycardia occurs when the sinus node regularly creates an impulse at a faster-than-normal rate. Atrial flutter occurs in the atrium and creates an atrial rate between 250 to 400 times per minute. Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial musculature. 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? Correct response:  "The client twiddles with or manipulates the generator or wires, causing the lead to fracture." Explanation: Twiddler syndrome may occur when the client manipulates the generator, causing lead dislodgement or fracture of the lead. 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? Correct response: Maze procedure Explanation: Clients who are not candidates for cardioversion and fail to respond to conventional measures may be candidates for a surgical intervention referred to as the Maze procedure. Angiography, open heart surgery, and heart transplantation are not recommended surgeries for these clients. Elective cardioversion is similar to defibrillation except that the electrical stimulation waits to discharge until an R wave appears. What does this prevent? Correct response:  Disrupting the heart during the critical period of ventricular repolarization Explanation: It is similar to defibrillation. One difference is that the machine that delivers the electrical stimulation waits to discharge until it senses the appearance of an R wave. By doing so, the machine prevents disrupting the heart during the critical period of ventricular repolarization. Therefore, the other options are incorrect. The nurse is assigned to care for several clients admitted to a telemetry unit. Which clients should the nurse assess first? Correct response:  A client whose implantable cardioverter defibrillator (ICD) fired twice on the prior shift, requiring amiodarone IV Explanation: The client’s implantable cardioverter defibrillator (ICD) that has fired on the previous shift should be seen first. This client is in need of antidysrhythmic medication, which is the priority intervention. The remaining clients should be seen after this client and are in no acute distress. CHAPTER 28 Following a coronary artery bypass graft, a client begins having chest "fullness" and anxiety. The nurse suspects cardiac tamponade and prints a lead II electrocardiogram (ECG) strip for interpretation. In looking at the strip, what change in the QRS complex would most support the nurse's suspicion? Correct response:  amplitude decreaseExplanation: An amplitude decrease would support the nurse's suspicion because fluid surrounding the heart, such as in cardiac tamponade, suppresses the amplitude of the QRS complexes on an ECG. Narrowing and widening complexes as well as an amplitude increase aren't expected findings on the ECG of an individual with cardiac tamponade. The nurse is teaching a client about mitral stenosis. What are pathophysiologic events occurring in mitral stenosis? Select all that apply. Correct response:  Pulmonary pressure increases.  Diastole is shortened.  Amount of time for forward flow is lessened. Explanation: Mitral stenosis decreases blood flow from the left atrium to the left ventricle during diastole. When heart rate increases, diastole is shortened, and the amount of time for forward flow is lessened; cardiac output decreases and pulmonary pressure increases, with blood backing up from the left atrium into the pulmonary veins. The nurse is assessing a client admitted with infective endocarditis. Which manifestation would the nurse expect to find? Correct response:  Small painful lesions on the pads of the fingers and toes Explanation: Primary presenting symptoms of infective endocarditis are fever and a heart murmur. In addition small, painful nodules (Osler nodes) may be present in pads of fingers or toes. Irregular red or purple, painless flat macules (Janeway lesions) may be present on palms, fingers, hands, soles, and toes. Hemorrhages with pale centers (Roth spots) caused by emboli may be observed in fundi of the eyes. Splinter hemorrhages (i.e., reddish-brown lines and streaks) may be seen under the proximal half of fingernails and toenails. Petechiae may appear in conjunctiva and mucous membranes. Cardiomegaly, heart failure, tachycardia, or splenomegaly may occur. A client is diagnosed with dilated cardiomyopathy. What is the most likely cause of the client's condition? Correct response:  chronic alcohol abuse Explanation: Chronic alcohol ingestion is one of the main causes of dilated cardiomyopathy. Other causes include history of viral myocarditis, an autoimmune response, and exposure toother chemicals in addition to alcohol. Heredity is considered the main cause of hypertrophic cardiomyopathy. Scleroderma is a connective tissue disorder thought to cause restrictive cardiomyopathy. Scar tissue that forms after a myocardial infarction is thought to be a cause of restrictive cardiomyopathy. A nurse suspects that a client has digoxin toxicity. The nurse should assess for: Correct response:  vision changes. Explanation: Vision changes, such as halos around objects, are signs of digoxin toxicity. Hearing loss can be detected through hearing assessment; however, it isn't a common sign of digoxin toxicity. Intake and output aren't affected unless there is nephrotoxicity, which is uncommon. Gait changes are also uncommon. Which is a key diagnostic indicator of heart failure? Correct response:  Brain natriuretic peptide (BNP) Explanation: BNP is the key diagnostic indicator of HF. High levels of BNP are a sign of high cardiac filling pressure and can aid in the diagnosis of heart failure. BUN, creatinine, and a CBC are included in the initial workup. A client with chronic heart failure is able to continue with his regular physical activity and does not have any limitations as to what he can do. According to the New York Heart Association (NYHA), what classification of chronic heart failure does this client have? Correct response:  Class I (Mild) Explanation: Class I is when ordinary physical activity does not cause undue fatigue, palpitations, or dyspnea. The client does not experience any limitation of activity. Class II (Mild) is when the client is comfortable at rest, but ordinary physical activity results in fatigue, heart palpitations, or dyspnea. Class III (Moderate) is when there is marked limitation of physical activity. The client is comfortable at rest, but less than ordinary activity causes fatigue, heart palpitations, or dyspnea. Class IV (Severe), the client is unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency occur at rest. Discomfort is increased if any physical activity is undertaken.The nurse is gathering data from a client recently admitted to the hospital. The nurse asks the client about experiencing orthopnea. What question would the nurse ask to obtain this information? Correct response:  "Are you only able to breathe when you are sitting upright?" Explanation: To determine if a client is having orthopnea, the nurse needs to ask about the inability to breathe unless sitting upright. Determining how far the client can walk without becoming short of breath would indicate exertional dyspnea. Coughing up blood would indicate hemoptysis. Urinating excessively at night can be indicative of different factors such as taking a diuretic late in the evening causing the client to urinate often at night. This question would be vague. The nurse assessing a client with an exacerbation of heart failure identifies which symptom as a cerebrovascular manifestation of heart failure (HF)? Correct response:  Dizziness Explanation: Cerebrovascular manifestations of heart failure stemming from decreased brain perfusion include dizziness, lightheadedness, confusion, restlessness, and anxiety due to decreased oxygenation and blood flow. A client with aortic stenosis is reluctant to have valve replacement surgery. A nurse is present when the health care provider talks to the client about a treatment that is less invasive than surgery which will likely relieve some of the client's symptoms. What treatment option has been discussed? Correct response:  Balloon percutaneous valvuloplasty Explanation: Definitive treatment for aortic stenosis is surgical replacement of the aortic valve. Clients who are symptomatic, but not good surgical candidates may benefit from a one or two balloon percutaneous valvuloplasty. Antibiotic therapy will not open the valve. The client does not want to have a valve replacement of any kind. The diagnosis of aortic regurgitation (AR) is confirmed by which of the following? Correct response:  EchocardiographyExplanation: Diagnosis is confirmed by echocardiography. Cardiac catheterization is not necessary in most patients with AR. Exercise stress testing will assess functional capacity and symptom response. A myocardial biopsy may be performed to analyze myocardial tissue cells in patients with cardiomyopathy. The nurse is teaching a client with cardiomyopathy. Which statement is a valid teaching point? Correct response:  The treatments include medications, medical devices, surgery, or transplantation. Explanation: Treatments for clients with cardiomyopathy include medications, medical devices such as pacemakers, internal defibrillators, surgery or transplantation. The disease is not curable or reversible. Clients with cardiomyopathy do not need to live in a skilled facility. The main goal for clients with cardiomyopathy is to improve heart function. A nurse is caring for a client with pericarditis and auscultates a pericardial friction rub.What action does the nurse ask the client to do to distinguish a pericardial friction rub from a pleural friction rub? Correct response:  The nurse asks the client to hold the breath during auscultation. Explanation: A pericardial friction rub occurs when the pericardial surfaces lose their lubricating fluid as a result of inflammation. The audible rub on auscultation is synchronous with the heartbeat. To distinguish between a pleural rub and a pericardial rub, the client should hold the breath. The pericardial rub will continue. Length of auscultation and standing would not assist in distinguishing one kind of rub from the other. A nurse is caring for a client receiving warfarin therapy following a mechanical valve replacement. The client had a prothrombin time and International Normalized Ratio (INR) drawn before breakfast. The laboratory report shows the client's INR reading was 4. What is the nurse's first priority ? Correct response:  Assess the client for bleeding and notify the health care provider of the results. Explanation: For a client taking warfarin following a valve replacement, the INR should be between 2 and 3.5. The nurse should notify the health care provider of an elevated INR level and communicate assessment data regarding possible bleeding. The nurse shouldn't administer medication such as warfarin or vitamin K without a health care provider'sorder. The nurse should notify the health care provider before holding a medication scheduled to be administered during another shift. A nurse is caring for a client with aortic stenosis whose compensatory mechanisms of the heart have begun to fail. The nurse will monitor the client carefully for which initial symptoms? Correct response:  Exertional dyspnea, orthopnea, pulmonary edema Explanation: When symptoms develop, clients with aortic stenosis usually first have exertional dyspnea, caused by increased pulmonary venous pressure from left heart failure. Orthopnea, paroxysmal nocturnal dyspnea, dizziness, and pulmonary edema may also occur. Nausea and vomiting may be signs of gastrointestinal congestion, but would be related to right heart failure, which does not occur initially with aortic stenosis. The nurse determines that a client recently diagnosed with subacute bacterial endocarditis understands discharge teaching upon which client statement? Correct response:  "I have to call my doctor so I can get antibiotics before seeing the dentist." Explanation: Antibiotic prophylaxis is recommended for high-risk clients immediately before and sometimes after dental procedures. The nurse understands that which of the following medications will be administered to the client for 6 to 12 weeks following prosthetic porcine valve surgery? Correct response:  Warfarin Explanation: To reduce the risk of thrombosis in patients with porcine or bovine tissue valves, warfarin is required for 6 to 12 weeks, followed by aspirin therapy. Furosemide would not be given for 6 to 12 weeks following this type of surgery. Digoxin may be used for the treatment of arrhythmias, but not just for 6 to 12 weeks. Which nursing intervention would reduce cardiac workload in a client with myocarditis? Correct response:  Maintain the client on bed rest. Explanation:The nurse should maintain the client on bed rest to reduce cardiac workload and promote healing. The nurse would administer a prescribed antipyretic only if the client has a fever. The nurse elevates the client’s head to promote maximal breathing potential. Treatment for myocarditis does not preclude allowing the client to have visitors or use the telephone. A nurse is assigned to the medical intensive care unit. The nurse ascultates a water-hammer pulse. What will the sound resemble? Correct response:  quick, sharp strokes that suddenly collapse Explanation: With the water-hammer (Corrigan’s) pulse, the pulse strikes the palpating finger with a quick, sharp stroke and then suddenly collapses. Water-hammer pulse is not low or high pitched. A clicking sound is heard with a valve replacement. During assessment of a client admitted for cardiomyopathy, the nurse notes the following symptoms: dyspnea on exertion, fatigue, fluid retention, and nausea. The initial appropriate nursing diagnosis is which of the following? Correct response:  Decreased cardiac output Explanation: A primary nursing diagnosis for cardiomyopathy is decreased cardiac output related to structural disorders caused by cardiomyopathy or to dysrhythmia from the disease process and medical treatments. Dyspnea on exertion, fatigue, and fluid retention are related to poor cardiac output. Nausea is related to poor perfusion of the gastrointestinal system. Autonomic dysreflexia is related to a spinal cord injury. Ineffective airway clearance relates to the inability to clear secretions from the airway, which is not an initial problem with cardiomyopathy. Disturbed sensory perception is related to specific senses and not to initial cardiomyopathy. A nurse is teaching a client about valve replacement surgery. Which statement by the client indicates an understanding of the benefit of an autograft replacement valve? Correct response:  “The valve is made from my own heart valve, and I will not need to take any blood-thinning drugs when I am discharged.” Explanation: Autografts (i.e., autologous valves) are obtained by excising the client’s own pulmonic valve and a portion of the pulmonary artery for use as the aortic valve. Anticoagulation is unnecessary because the valve is the client’s own tissue and is not thrombogenic.The autograft is an alternative for children (it may grow as the child grows), women of childbearing age, young adults, clients with a history of peptic ulcer disease, and people who cannot tolerate anticoagulation. Aortic valve autografts have remained viable for more than 20 years. A client with a myocardial infarction develops acute mitral valve regurgitation. The nurse knows to assess for which manifestation that would indicate that the client is developing pulmonary congestion? Correct response:  Shortness of breath Explanation: Chronic mitral regurgitation is often asymptomatic, but acute mitral regurgitation (e.g., resulting from a myocardial infarction) usually manifests as severe congestive heart failure. Dyspnea, fatigue, and weakness are the most common symptoms. Palpitations, shortness of breath upon exertion, and cough from pulmonary congestion also occur. A loud, blowing murmur often is heard throughout ventricular systole at the apex of the heart. Hypertension may develop when reduced cardiac output triggers the reninangiotensin-aldosterone cycle. Tachycardia is a compensatory mechanism when stroke volume decreases. The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for? Correct response:  Cardiac tamponade Explanation: The inflammatory process of pericarditis may lead to an accumulation of fluid in the pericardial sac (pericardial effusion) and increased pressure on the heart, leading to cardiac tamponade A nurse is admitting a client with hypertrophic cardiomyopathy (HCM). What medication order will the nurse question? Correct response:  isosorbide dinitrate Explanation: Isosorbide dinitrate is a nitrates that should be avoided in HCM to maintain cardiac output. Enalapril is an ACE inhibitor, metoprolol is a beta blocker, and spironolactone is an aldosterone antagonist used for HCM. Which type of graft is used when a heart valve replacement is made of tissue from an animal heart valve?Correct response:  Heterograft Explanation: Heterograft, also called bioprosthesis, refers to replacement of tissue from animal tissue, usually pigs but also cows or horses. An autograft is a heart valve replacement made from the client's own heart valve. Allograft refers to replacement using human tissue and is a synonym for homograft. The nurse assessing a patient with pericardial effusion at 0800 notes the apical pulse is 74 and the BP is 140/92. At 1000, the patient has neck vein distention, the apical pulse is 72, and the BP is 108/92. Which action would the nurse implement first? Correct response:  Stay with the patient, use a calm voice, and ask for assistance via call light. Explanation: The nurse stays with the patient and continues to assess and record signs and symptoms while intervening to decrease patient anxiety. The pulse pressure is narrowing, and the patient is experiencing neck vein distention, indicative of rising central venous pressure. After reaching assistance via the call light from the patient's beside, the nurse notifies the physician immediately and prepares to assist with diagnostic echocardiography and pericardiocentesis. A left lateral recumbent position is used when administering enemas. Morphine would be given to someone who may be experiencing a myocardial infarction, not cardiac tamponade. A client comes to the clinic reporting fever, chills, and sore throat and is diagnosed with streptococcal pharyngitis. A nurse knows that early diagnosis and effective treatment is essential to avoid which preventable disease? Correct response:  Rheumatic fever Explanation: Rheumatic fever is a preventable disease. Diagnosing and effectively treating streptococcal pharyngitis can prevent rheumatic fever and thereby rheumatic heart disease. A nurse working at a pediatric clinic is teaching a group of parents. A parent asks the nurse if it is okay to let the young child recover from a sore throat naturally, rather than bringing the child to the clinic for diagnosis and treatment. What is the nurse's best response? Correct response:  "It may be streptococcal sore throat. Rheumatic heart disease can be prevented with early treatment."Explanation: A sore throat may be streptoccocal pharyngitis. Diagnosing and treating the sore throat can prevent rheumatic fever and, therefore, rheumatic heart disease. Letting children recover naturally can be dangerous if the sore throat is a strotococcal infection. The use of antibiotics is considered by each prescribing heath care provider. General statements about treatments are not helpful. A client is diagnosed with pericarditis. What symptom will be the nurse's priority for treatment? Correct response:  acute pain Explanation: Pain is the primary symptom of the client with pericarditis. Pain relief and the absence of complications are two major nursing goals.The client may have anxiety, fatigue, or denial, but these symptoms are not the nurse's priority for care. A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. Which client statement indicates to the nurse a need for additional teaching? Correct response:  "I can still drink coffee and tea." Explanation: The client requires more teaching if he states that he may drink coffee and tea. Caffeine is a stimulant, which can exacerbate palpitations, and should be avoided by a client with symptomatic mitral valve prolapse. High fluid intake helps maintain adequate preload and cardiac output. Aerobic exercise helps increase cardiac output and decrease heart rate. Protein-rich foods aren't restricted but high-calorie foods are. Which nursing intervention should a nurse perform when a client with cardiomyopathy receives a diuretic? Correct response:  Check regularly for dependent edema Explanation: The nurse should regularly monitor for dependent edema if the client with cardiomyopathy receives a diuretic. Oxygen is administered either continuously or when dyspnea or dysrhythmias develop. Bed rest is not necessary. The nurse should ensure that the client's activity level is reduced and should sequence any activity that is slightly exertional between periods of rest. A client with a history of cardiomyopathy experiences dyspnea on exertion, fatigue, leg swelling, and chest pain. This client has which type of cardiomyopathy?Correct response:  dilated cardiomyopathy Explanation: Dilated cardiomyopathy, the most common type, is accompanied by dyspnea on exertion and when lying down. The client experiences fatigue and leg swelling and may also have palpitations and chest pain. Peripartum cardiomyopathy may develop in women shortly before or after giving birth. Hypertrophic cardiomyopathy is associated with syncope, fatigue, SOB, and chest pain. Restrictive cardiomyopathy has symptoms of exertional dyspnea, dependent edema in the legs, ascites (fluid in the abdomen), and hepatomegaly (enlarged liver). A nurse reviewing a client’s echocardiogram report reads the following statements: “The heart muscle is asymmetrically thickened and the overall size and mass are increased, especially along the septum. The ventricular walls are thickened, reducing the size of the ventricular cavities. Several areas of the myocardium show evidence of scaring.” The nurse knows these manifestations are indicative of which type of cardiomyopathy? Correct response:  Hypertrophic Explanation: In hypertrophic cardiomyopathy (HCM), the heart muscle asymmetrically increases in size and mass, especially along the septum. It often affects nonadjacent areas of the ventricle. The increased thickness of the heart muscle reduces the size of the ventricular cavities and causes the ventricles to take a longer time to relax after systole. The coronary arteriole walls are also thickened, which decreases the internal diameter of the arterioles. The narrow arterioles restrict the blood supply to the myocardium, causing numerous small areas of ischemia and necrosis. The necrotic areas of the myocardium ultimately fibrose and scar, further impeding ventricular contraction. Because of the structural changes, HCM had also been called idiopathic hypertrophic subaortic stenosis (IHSS) or asymmetric septal hypertrophy (ASH). Restrictive (or constrictive) cardiomyopathy (RCM) is characterized by diastolic dysfunction caused by rigid ventricular walls that impair ventricular stretch and diastolic filling. Arrhythmogenic right ventricular cardiomyopathy (ARVC) occurs when the myocardium of the right ventricle is progressively infiltrated and replaced by fibrous scar and adipose tissue. A client with a mechanical valve replacement asks the nurse, "Why do I have to take antibiotics before getting my teeth cleaned?" What is the nurse's best response? Correct response:  "You are at risk of developing an infection in your heart." Explanation:The patient is at risk for endocarditis and should take prophylactic antibiotics before any invasive procedure. Antibiotics have nothing to do with how much the teeth bleed. Cleaning of the teeth will not cause the valve to malfunction. Using the word "vegetative" with the patient may not be understood; therefore, it is not the most appropriate answer. A nurse and a nursing student are performing a physical assessment of a client with pericarditis. The client has an audible pericardial friction rub on auscultation. When leaving the room, the student asks the nurse what causes the sound. The nurse's best response is which of the following? Correct response:  "The pericard