Labs/Diagnostics
This test provides information regarding the workload of the heart and is discontinued once the heart rate reaches a certain rate.
Can be done physically or with a chemical.
This test is indicated for angina, heart failure, MI, and dysrhythmias.
Stress Testing
A male patient with heart failure is prescribed spironolactone. What side effects should the patient monitor for?
Hyperkalemia--muscle weakness, fatigue, or arrythmias
Gynecomastia (breast enlargement)
Libido or ED
N/V, dehydration
After a coronary artery stent placement, what medications would the patient be prescribed long-term?
Aspirin indefinitely
Clopidogrel (Plavix) x 1 year
The IV pump is running heparin 5,000 unity in 500 mL of NS at 20 mL/hr. How many units are infused over 8 hours?
1,600 units
A nurse in a provider's office is monitoring blood electrolytes for four clients who take digoxin. Which of the following electrolyte values increase a client's risk digoxin toxicity?
A. Calcium 9.2 mg/dL
B. Calcium 10.3 mg/dL
C. Potassium 3.4 mEq/L
D. Potassium 4.8 mEq/L
C
This is an invasive diagnostic procedure used to evaluate the presence and degree of coronary artery blockage
Angiography or cardiac catheterization
A patient has been started on Lisinopril (Zestril) for high blood pressure. What side effects should the patient monitor for and report to the provider?
Dry cough
Hyperkalemia
Angioedema
After a cardiac catheterization, how often should the nurse assess the site and vital signs?
q15 min x 4, q30 x4, hourly x4
Order is for pantoprazole 40 mg in 100 mL NS to infuse over 15 minutes. At what rate (mL/hr) should you set the pump? Round to the nearest whole number.
400 mL/hr
A nurse caring for a group of clients. The nurse should recognize which of the following clients is at risk for the development of a dysrhythmia? Select all that apply.
A. A client with metabolic alkalosis
B. A client with a 4.3 potassium level
C. A client with an O2 of 96%
D. A client with an ETOH use disorder
E. A client who underwent stent placement in a coronary artery.
A, C, E
This can be found on an echocardiogram report and describes the amount of volume that leaves the left ventricle with each heartbeat
Ejection Fraction
A patient on warfarin therapy for afib is asking about dietary considerations. What dietary education should the nurse provide?
Avoid foods high in vitamin K-
Broccoli, spinach, kale, collard greens, brussels sprouts, blueberries, vegetable oil, pomegranate juice, pumpkin, grapes,
Minimize shoulder movement (sling)- no lifting >5-10 lbs, no raising arm above shoulder) for several weeks to prevent lead dislodgement
Order is to infuse 50 mL of D5W over 15 minutes. You have IV tubing with a drop gactor if 20 gtts/mL available. How many gtts/min should be delivered to the patient? Round to the nearest whole number.
67 gtts/min
A nurse is assessing a client taking amiodarone. Which of the following is a manifestation of amiodarone toxicity?
A. Light yellow urine
B. Report of tinnitus
C. Productive cough
D. Blue-gray skin discoloraion
Productive cough can indicate pulmonary toxicity or heart failure.
This is a protein found in myocardial cells that leaks with myocardial injury
Troponin
A patient admitted to the floor with afib and is being put on digoxin, what are the signs of digoxin toxicity?
Toxicity: N/V/D, blurred vision, halo effect, HA, drowsiness, confusion, disorientation (comes from hypOkalemia, kidney injury, decreased GFR)
After a mechanical valve replacement, patients will require lifelong __________
Anticoagulant therapy
Order is for propofol 5 mcg/kg/min. The patient weighs 121 lbs. Propofol 1,000 mg/100 mL is available. What is the IV pump rate in mL/hr? Round to the nearest tenths place.
1.7 mL/hr
A nurse is admitting a client who has a suspected myocardial infarction (MI) and a history of angina. Which of the following findings will help the nurse distinguish stable angina from an MI?
A. Stable angina can be relieved with rest and nitroglycerin.
B. The pain of an MI resolved in less than 15 min.
C. The type of activity that causes and MI can be identified.
D. Stable angina can occur for longer than 30 minutes.
A. Stable angina can be relieved with rest and nitroglycerin.
BONUS QUESTION:
Describe the flow of blood through the heart (including the valves)
In through Vena Cava to RA
-RA through Tricuspid valve to the RV
-RV through the pulmonic valve to the L&R pulmonary arteries
-to the lungs; back in through the L&R pulmonary veins
-PVs to LA through the Mitral valve to the LV
-LV through aortic valve, through aortic arch, down the descending aorta to the body
What medication class, when given with beta blockers, can intensify the effects of beta blockers?
Calcium Channel Blockers.
Can cause: decreased HR, myocardial contractility, and rate of conduction through the AV node.
In the second phase of cardiac rehab, what should teaching be focused on?
Increasing activity and exercise, and identifying risk factors for modifications
Order is for norepinephrine 0.3 mcg/kg/min. The patient weighs 110 lbs. Norepinephrine 8 mg/250 mL is available. What is the pump rate in mL/hr? Round to the nearest tenth.
28.1 mL/hr
A nurse is caring for a client who has pericarditis. Which of the following findings should the nurse expect? Select all that apply.
A. Petechia
B. Friction rub
C. Splinter hemorrhages under the nails
D. Cough
E. Chest pain
B, D, E