Some Questions
A client is in sinus bradycardia with a heart rate of 45 beats/min, complains of dizziness, and has a blood pressure of 82/60 mm Hg. Which of the following should the nurse anticipate will be prescribed? A). Defibrillate the client B). Administer digoxin (Lanoxin) C). Continue to monitor the client D). Prepare the transcutaneous pacing
Ans: D Hypotension and dizziness are signs of decreased cardiac output. Transcutaneous pacing provides a temporary measure to increase the heart rate and thus perfusion in the symptomatic client. Digoxin will further decrease the client’s heart rate. Defibrillation is used for treatment of pulseless ventricular tachycardia and ventricular fibrillation. Continuing to monitor the client delays necessary intervention.
Your patient returns from his angiogram procedure. Which of these symptoms is concerning? Check all that apply.
A) atrial fibrillation
B) numbness in one leg
C) bleeding at the site
D) back pain
Any new numbness or tingling in the affected limb could indicate an internal bleed. Frank bleeding at a femoral site is an emergency. RN should apply manual pressure for 15 minutes and call for help and assess stability. New hematomas should also have pressure held for this length of time. New lower back pain could be indicative of a retroperitoneal bleed.
A P - Wave on the ECG represents this
Atrial depolarization or contraction and SA node activity.
Explain to me how to take nitroglycerin for Chest Pain (dose, frequency, side effects, etc).
0.5 mg nitro tablets can be used up to 3 times at home 5 minutes apart. If CP not resolved after first dose, call EMS. Make sure you sit down while taking this, because Nitro opens up the blood vessels and may make you lightheaded or have low blood pressure and have a headache.
A patient diagnosed with thrombophlebitis 1 day ago suddenly complains of chest pain and shortness of breath and is visibly anxious. The nurse should immediately assess the client for signs and symptoms of which of the following? A) Pneumonia B) Pulmonary edema C) Pulmonary embolism D) Myocardial infarction
Ans: B Pulmonary embolism is a life-threatening complication of deep vein thrombosis and thrombophlebitis. Chest pain is the most common symptom, which is sudden in onset, and may be aggravated by breathing. Other signs and symptoms include dyspnea, cough, diaphoresis, and apprehension.
A nurse is conducting a health history of a client with a primary diagnosis of heart failure. Which of the following disorders reported by the client is unlikely to play a role in exacerbating the heart failure? A) Atrial fibrillation B) Nutritional anemia C) Peptic ulcer disease D) Recent upper respiratory infection
Ans: C Heart failure is precipitated or exacerbated by physical or emotional stress, dysrhythmias, infections, anemia, thyroid disorders, pregnancy, Paget’s disease, nutritional deficiencies (thiamine, alcoholism), pulmonary disease, and hypervolemia
A nurse notes bilateral +2 edema in the lower extremities of a client with myocardial infarction who was admitted 2 days ago. The nurse would plan to do which of the following next? A) Have the physician order a Lower Extremity Ultrasound B) Review the intake and output records for the last 2 days C) Request a sodium restriction of 1g/day from the physician D) Change the time of diuretic administration from morning to evening
Ans: B Edema, the accumulation of excess fluid in the interstitial spaces, can be measured by intake greater than output and by a sudden increase in weight. Diuretics should be given in the morning whenever possible to avoid nocturia. Strict sodium restrictions are reserved for clients with severe symptoms.
A QRS complex on an ECG represents this
Ace Inhibitors do this for cardiac patients
ACE inhibitors, or angiotensin (generic name) converting enzyme inhibitors, is a class of drugs that interact with blood enzymes to enlarge or dilate blood vessels and reduce blood pressure. This helps This helps perfuse the kidneys. Be on the lookout for that darn ACE cough though!
A home care nurse is making a routine visit to a client receiving digoxin (Lanoxin) in the treatment of heart failure. The nurse would particularly assess the client for which of the following? A) Diarrhea and hypotension B) Fatigue and muscle twitching C) Thrombocytopenia and weight gain D) Anorexia, nausea, and visual disturbances
Ans: D The first signs and symptoms of digoxin toxicity in adults include abdominal pain, nausea, vomiting, visual disturbances (blurred, yellow, or green vision, halos around lights), bradycardia, and other dysrhythmias. Options 1, 2, and 3 are unrelated to digoxin therapy.
A client with myocardial infarction suddenly becomes tachycardic, shows signs of air hunger, and begins coughing frothy, pink-tinged sputum. Which of the following would the nurse anticipate when auscultating the client's breath sounds? A) Stridor B) Crackles C) Scattered rhonchi D) Diminished breath sounds
Ans: B Pulmonary edema is characterized by extreme breathlessness, dyspnea, air hunger, and the production of frothy, pink-tinged sputum. Auscultation of the lungs reveals crackles. Rhonchi and diminished breath sounds are not associated with pulmonary edema. Stridor is a crowing sound associated with laryngospasm or edema of the upper airway.
Cardiac magnetic resonance imaging (MRI) is prescribed for a client. The nurse identifies that which of the following is a contraindication for performance of this diagnostic study? A) Client has a pacemaker B) Client is allergic to iodine C) Client has diabetes mellitus D) Client has a biological porcine valve
Ans: A The magnetic fields used for magnetic resonance imaging (MRI) can deactivate the pacemaker. Options 2, 3, and 4 are not contraindications for an MRI.
The QT on an ECG interval represents this
Ventricular depolarization and repolarization
You check your patient's AM labs and this is what they are:
Creatinine: 2.7
K: 3.2
NA: 135
HGB: 12.0
Which of their morning medications would you hold?
A) MetoprololB) Cozaar
C) SimvastatinD) Torsemide
D: Torsemide is processed through the kidneys and we wouldn't want to make them worse. Also, the K is low, and we wouldn't want to give the torsemide until we have repleted the K.
A nurse is monitoring a client with acute pericarditis for signs of cardiac tamponade. Which assessment finding would indicated the presence of this complication? A) A pulse rate of 60 beats/min B) Flat neck veins C) Muffled or distant heart sounds D) A blood pressure (BP) of 128/82 mm Hg
Ans: C Assessment findings associated with cardiac tamponade include tachycardia, distant or muffled heart sounds, jugular vein distention, and a falling blood pressure accompanied by pulsus paradoxus (a drop in inspiratory BP greater than 10 mm Hg). Bradycardia is not a sign of cardiac tamponade.
A nurse is providing instruction regarding high-sodium food items to avoid to a client with a diagnosis of hypertension. The nurse instructs the client to avoid (Check all that apply): A) Cantaloupe B) Ketchup C) Canned Soup D) Bananas
Ans: B and C
Salt is used as a preservative in canned , boxed, jarred food.
A nurse is performing an assessment on a client with a diagnosis of left-sided heart failure. Which assessment component would elicit specific information regarding the client's left-sided heart function? A) Listening to lung sounds B) Assessing for peripheral and sacral edema C) Assessing for jugular vein distenstion D) Monitoring for organomegaly
Ans: A The client with heart failure may present with different symptoms depending on whether the right or the left side of the heart is failing. Peripheral and sacral edema, jugular vein distention, and organomegaly all are manifestations of problems with right-sided heart function. Lung sounds constitute an accurate indicator of left-sided heart function.
How do you know if your patient has a paced rhythm?
White pacemaker spikes before the PR or QRS intervals (or both!)
A nurse is preparing for the admission of a client with heart failure who is begin sent directly to the hospital from the physician's office. The nurse would plan on having which of the following medications readily available for use? A) Digoxin (Lanoxin) B) Verapamil (Calan) C) Propranolol (Inderal) D) Diltiazen (Cardizem)
Ans: A Digoxin exerts a positive inotropic effect on the heart while slowing the overall rate through a variety of mechanisms. Digoxin is the medication of choice to treat heart failure. Diltiazem and verapamil (calcium channel blockers) and propranolol (β-adrenergic blocker) have a negative inotropic effect and would worsen the failing heart.
A client is scheduled to undergo cardiac catheterization for the first time, and the nurse provides instructions to the client. Which client statement indicates a clear understanding of the instructions? A) “I will have to go to the operating room for this procedure.” B) “I probably will feel tired after the test from lying on a hard x-ray table for a few hours.” C) “It will really hurt when the catheter is first put in.” D) “I will receive general anesthesia for the procedure.”
Ans: B It is common for the client to feel fatigued after the cardiac catheterization procedure. Other pre-procedure teaching points include that the procedure is done in a darkened cardiac catheterization room. A local anesthetic is used, so little to no pain is experienced with catheter insertion. General anesthesia is not used. The x-ray table is hard and may be tilted periodically, and the procedure may take 1 to 2 hours. The client may feel various sensations with catheter passage and dye injection.
Your patient is bridging with IV Heparin after his procedure. You would continue overlap therapy with Coumadin until his level reaches:
A) 1-2
B) 2-3
C) 1-3
D) 2-4
B - unless the patient has other risk factors, such as mechanical valves, multiple CVA, etc. they may need theirs higher.
A client is being discharged from the hospital after being treated for infective endocarditis. The nurse provides the client with which discharge instructions? A) Take acetaminophen (Tylenol) if the chest pain worsens B) Use a firm bristle toothbrush and floss vigorously to prevent cavities C) Take antibiotics until the chest pain is fully resolved D) Notify all health care providers of the history of infective endocarditis before any invasive procedures
Ans: D The client should alert any health care provider about the history of infective endocarditis before any procedure that involves instrumentation. The provider should place the client on prophylactic antibiotics. Antibiotics should be taken for the full course of therapy. The client should notify the physician if chest pain worsens or if dyspnea or other symptoms occur. The client should use a soft toothbrush and floss carefully to avoid any trauma to the gums, which could provide a portal of entry for bacterial infection.
You look at your patients ECG and note the QT length. At what number would you get concerned about your patient going into an arrhythmia?
500 or 550 if paced. You would review medications list as well to make sure nothing we give will prolong it.
A nurse is assessing a client with and abdominal aortic aneurysm. Which of the following assessment findings by the nurse is probably unrelated to the aneurysm? A) Pulsatile abdominal mass B) Hyperactive bowel sounds in the area C) Systolic bruit over the area of the mass D) Subjective sensation of “heart beating” in the abdomen
Ans: B Not all clients with abdominal aortic aneurysm exhibit symptoms. Those who do may describe a feeling of the “heart beating” in the abdomen when supine or being able to feel the mass throbbing. A pulsatile mass may be palpated in the middle and upper abdomen. A systolic bruit may be auscultated over the mass. Hyperactive bowel sounds are not related specifically to an abdominal aortic aneurysm.
A client is brought into the ER with a third degree heart block after experiencing an acute anterior myocardial infarction. Which of the following interventions is the priority on an emergency basis? A) Temporary Pacemaker B) Administer Lidocaine C) Cardioversion D) Administer Atropine
Ans. A) A third degree heart block is a lethal rhythm. It is the complete blockage of the atrial impulses into the ventricles.