EKG
On a standard EKG tracing, what electrical event in the heart does the P wave represent?
Atrial depolarization.
Rationale: The P wave represents the spread of the electrical impulse from the SA node through the atrial myocardium.
Which clinical clinical manifestation is most characteristic of left-sided heart failure rather than right-sided heart failure?
Pulmonary crackles / dyspnea / orthopnea
A client with essential hypertension asks why they must take their prescribed hydrochlorothiazide daily even if they feel fine. What feature of HTN explains this necessity?
Answer: Hypertension is often asymptomatic ("the silent killer") and causes progressive end-organ damage if untreated.
Rationale: Uncontrolled blood pressure damages vascular endothelium silently over time, leading to target-organ failure.
A client experiences bilateral leg pain during walking that resolves with 5 minutes of rest. What clinical term describes this symptom?
Answer: Intermittent claudication.
Rationale: Inadequate arterial blood flow during exertion causes muscle ischemia, which subsides as oxygen demand drops during rest
A client with coronary artery disease reports chest pressure after walking that improves after sitting down and resting. Which condition does the nurse suspect?
Answer:
Stable angina
Rationale:
Stable angina occurs when myocardial oxygen demand increases, such as during activity, but improves with rest because oxygen demand decreases.
What is the normal measurement duration for a standard PR interval on an EKG?
Answer: 0.12 to 0.20 seconds (3 to 5 small boxes).
Rationale: The PR interval measures the time taken for depolarization to spread from the SA node through the AV node to the ventricles
What laboratory value rises directly in response to increased ventricular wall stretch and helps confirm a heart failure exacerbation?
B-type Natriuretic Peptide (BNP).
Rationale: BNP is neurohormonally secreted by cardiac ventricles when volume overload increases myocardial wall tension
Which statement by a client taking an antihypertensive medication requires further teaching?
A. “I will check my blood pressure regularly.”
B. “I will stop the medication once my blood pressure is normal.”
C. “I will change positions slowly.”
D. “I will take the medication as prescribed.”
B. “I will stop the medication once my blood pressure is normal.”
Rationale:
Hypertension is often chronic and asymptomatic. Antihypertensive medications should not be stopped without provider guidance.
How should a client with Peripheral Artery Disease (PAD) position their legs to relieve pain at rest, compared to a client with Peripheral Venous Disease?
Answer: Dangle/depend their legs below heart level (PAD), whereas Venous Disease requires leg elevation.
Rationale: Gravity assists arterial flow into peripheral tissues in PAD; elevation promotes venous return in venous disease.
The nurse is teaching a client with CAD about risk-factor modification. Which statement indicates the client needs further teaching?
A. “I will stop smoking.”
B. “I will exercise regularly as recommended.”
C. “I should increase foods high in saturated fat.”
D. “I will work toward maintaining a healthy weight.”
C. “I should increase foods high in saturated fat.”
Rationale:
Saturated fats contribute to atherosclerosis and increase cardiovascular risk. Clients with CAD should reduce saturated and trans fats and follow a heart-healthy diet.
An EKG tracing reveals a rhythm with no identifiable P waves, irregular ventricular response, and a chaotic baseline. What rhythm is present?
Answer: Atrial Fibrillation.
Rationale: Atrial fibrillation causes rapid, disorganized atrial activation leading to an irregularly irregular ventricular rhythm
Which daily assessment is most important for a client with heart failure?
Daily weight
Rationale:
Daily weight is a sensitive indicator of fluid retention. A rapid increase may indicate worsening heart failure and fluid overload.
SATA:
The nurse is teaching a client with hypertension about lifestyle modifications. Which interventions should the nurse include?
A. Follow a low-sodium diet.
B. Maintain a healthy weight.
C. Increase regular physical activity.
D. Stop taking prescribed medications once BP improves.
E. Limit excessive alcohol intake.
Answer:
A, B, C, E
Rationale:
Reducing sodium, maintaining a healthy weight, exercising, and limiting alcohol can lower blood pressure and cardiovascular risk. Prescribed medications should not be stopped independently.
Which assessment finding is most consistent with peripheral arterial disease?
A. Warm leg with brown pigmentation
B. Edema and a warm, red extremity
C. Cool, pale foot with diminished pulses
D. Bilateral dependent edema
C. Cool, pale foot with diminished pulses
Rationale:
Arterial disease decreases blood flow, producing coolness, pallor, diminished pulses, delayed capillary refill, and possible pain.
What key modifiable risk factor contributes most significantly to endothelial injury and the development of atherosclerosis in CAD?
Answer: Hyperlipidemia (or smoking/uncontrolled hypertension).
Rationale: Elevated low-density lipoproteins (LDLs) penetrate damaged arterial endothelium, forming fatty streaks that progress to stable or unstable atheromatous plaques.
A client's telemetry monitor shows a broad, wide QRS complex rhythm without P waves at a rate of 160 bpm. What is the priority assessment action?
Answer: Check the client's pulse and responsiveness immediately (determining Ventricular Tachycardia stability).
Rationale: Ventricular Tachycardia can be pulseless or unstable; treatment depends entirely on clinical pulse status.
A client with HF is receiving furosemide IV push. Which clinical parameters must the nurse evaluate before and after administration?
Serum potassium levels, blood pressure, daily weights, and urine output.
Rationale: Loop diuretics induce rapid diuresis, risking hypokalemia, volume depletion, and hypotension.
What finding differentiates a Hypertensive Emergency from a Hypertensive Urgency in a client presenting with a blood pressure of 210/120 mmHg?
Answer: Presence of acute target-organ damage (e.g., encephalopathy, acute renal failure, papilledema).
Rationale: Hypertensive emergency requires immediate controlled blood pressure reduction due to active end-organ destruction.
The nurse is caring for a client with PAD. Which intervention is most appropriate?
A. Apply a heating pad to the feet.
B. Encourage smoking cessation.
C. Keep the legs elevated above the heart.
D. Apply compression stockings without assessment.
B. Encourage smoking cessation.
Rationale:
Smoking causes vasoconstriction and accelerates atherosclerosis, making PAD worse. Smoking cessation is one of the most important modifiable interventions.
A nurse is assessing a client presenting with severe retrosternal chest pain radiating to the left arm. Which diagnostic finding is the most specific biomarker for myocardial infarction?
Answer: Cardiac Troponin I or T.
Rationale: Troponins are highly sensitive and specific cardiac proteins released into circulation only when myocardial cell damage occurs.
How does a Second-Degree AV Block Type I (Wenckebach) differ on an EKG tracing from a Second-Degree AV Block Type II (Mobitz II)?
Answer: Type I shows progressive lengthening of the PR interval until a QRS is dropped; Type II has fixed PR intervals before dropped QRS complexes.
Rationale: Type I involves variable conduction delay in the AV node, while Type II is an all-or-nothing conduction failure below the AV node.
A client with heart failure taking digoxin reports nausea, visual halos, and a heart rate of 48 bpm. What is the priority action?
Answer: Hold the digoxin dose and notify the healthcare provider immediately (suspecting digoxin toxicity).
Rationale: GI symptoms, visual disturbances, and bradycardia are classic signs of digitalis toxicity, exacerbated by hypokalemia
A client is starting spironolactone for hypertension management. What electrolyte imbalance requires close laboratory monitoring?
Answer: Hyperkalemia.
Rationale: Spironolactone is a potassium-sparing diuretic that inhibits aldosterone at the distal tubule, leading to potassium retention.
SATA:
Which findings would the nurse expect in a client with peripheral arterial disease?
A. Diminished peripheral pulses
B. Cool extremity
C. Pain with activity
D. Dependent rubor
E. Warm, edematous leg
Answer:
A, B, C, D
Rationale:
PAD decreases arterial perfusion. Expected findings include diminished pulses, cool skin, intermittent claudication, and dependent rubor. Significant warmth and edema are more characteristic of venous problems.
A client with CAD has the following findings:
Which finding is the highest priority?
Answer:
The new ST-segment changes accompanied by hypotension and chest pain
Rationale:
These findings strongly suggest acute myocardial ischemia with impaired cardiac perfusion. Hypotension indicates compromised circulation and requires immediate intervention.