Fetal & Cardiac Monitoring
Accelerations are increases in the fetal heart rate. All of the following statements are true except;
a. the FHR will increase by 12 bpm and this will last for 12 secs
b. Accelerations are usually associated with fetal movement
c. a reassuring pattern
d. used in non-stress testing to surviel the fetus
Answer: A. the FHR will increase by 12 bpm and this will last for 12 secs
An elderly client is being monitored for evidence of congestive heart failure. To detect early signs of heart failure, the nurse would instruct the certified nursing attendant (CNA) to do which of the following during care of the patient?
A) Observe electrocardiogram readings and report deviations to the nurse.
B) Assist the client with ambulation three times during the shift.
C) Monitor vital signs every 15 minutes and report each reading to the nurse.
D) Accurately weigh the patient, and report and record the readings.
D) Accurately weigh the patient, and report and record the readings.
Rationale: Due to fluid accumulation, an expanded blood volume can result when the heart fails. Body weight is a sensitive indicator of water and sodium retention, which will manifest itself with edema, dyspnea - especially nocturnal - and pedal edema. Patients also should be instructed about the need to perform daily weights upon discharge to monitor body water. It is not within the role of the CNA to monitor ECG readings, and ambulation is not an assessment. Vital signs every 15 minute are not necessary for this level of patient care.
A) Aspirin (acetylsalicylic acid)
B) Warfarin sodium (Coumadin)
C) Simvastatin (Zocor)
D) Vinorelbine tartrate (Navelbine)
Answer:
B) Warfarin sodium (Coumadin)Rationale: Chronic atrial fibrillation places a patient at high risk for clot formation. Warfarin sodium frequently is ordered as an anti-coagulant. Aspirin will not prevent clots associated with atrial fibrillation. Zocor is used to lower LDL and increase HDL. Navelbine is an anti-neoplastic.
A) Increasing lower-density lipoprotein.
B) Controlling lower-density lipoprotein.
C) Increasing triglycerides.
D) Increasing very low-density lipoprotein.
Rationale: The Heart Protective Study has also shown that controlling low-density lipoprotein (LDL) with simvastatin (Zocor) assists in the prevention of coronary heart disease by raising HDL. Responses 1, 3, and 4 are incorrect.
Which of the following are most likely to be early signs of cardiac problems in older persons? (Select all that apply.)
A) Mental status changes
B) Agitation
C) Frequent falls
D) Sudden changes in GI function
A) Mental status changes
B) Agitation
C) Frequent falls
Rationale: Many cardiovascular functions are complicated in that they involve many other systems. Mental status changes, agitation, and falls can be early signs of cardiac problems in the older person. Changes in function in the GI system are not typical signs of a cardiac problem.
Early decelerations with moderate fetal variability during labor have which of the following indications?
a. often indicates congenital heart disease
b. indicates compression of the fetal head
c. indicates fetal hypoxia
d. may indicate fetal acidemia
Answer: B. indicates compression of the fetal head
A) Evaluate blood flow to peripheral tissues.
B) Determine the electrical activity of the myocardium.
C) Provide information on the immediate need for oxygen.
D) Implement nutritional changes.
Rationale: Blood flow to the tissues is measured clinically as the cardiac output, and assists to predict tissue perfusion. Electrical activity is evaluated more effectively by EKG. While the cardiac output is important for perfusion and oxygenation of tissues, the oxygen saturation would provide more valuable information. Nutritional changes would be targeted to sodium and would depend on symptoms of disease.
A) Check the client status and lead placement
B) Press the recorder button on the electrocardiogram console.
C) Call the physician
D) Call a code blue
Rationale: Sudden loss of electrocardiogram complexes indicates ventricular asystole or possible electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention.
A) Sublingual nitroglycerin
B) Cardiac glycosides
C) HMG-CoA reductase inhibitors
D) Morphine sulfate
Rationale: Angina frequently is managed with sublingual nitroglycerin, which causes vasodilation and increases blood flow to the coronary arteries. Cardiac glycosides are used to treat heart failure, and morphine is used to treat myocardial infarction. The HMG-CoA reductase inhibitors are used for patients with type 2 diabetes mellitus.
The nurse knows the following are conditions associated with fetal tachycardia.
SELECT ALL THAT APPLY
a. Maternal hypotension
b. Infection
c. Prolonged umbilical cord compression
d. Fetal anemia
e. Drugs like betamethasone
Answers:
b. Infection
c. Prolonged umbilical cord compression
d. Fetal anemia
e. Drugs like betamethasone
A nurse is assessing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 second, and QRS complexes measure 0.06 second. The overall heart rate is 64 beats per minute. The nurse assesses the cardiac rhythm as:
A ) Normal sinus rhythm
B ) Sinus bradycardia
C ) Sick sinus syndrome
D ) First-degree heart block
Answer:
A) NSR
Rationale: measurements are normal, measuring 0.12 to 0.20 second and 0.4 to 0.10 second, respectively.
A) Left atrium
B) Right atrium
C) Right ventricle
D) Left ventricle
Rationale: The right atrium is a thin-walled structure that receives deoxygenated blood from all the peripheral tissues by way of the superior and inferior vena cava and from the heart muscle by way of the coronary sinus.
A) Premature ventricular contractions
B) Ventricular tachycardia
C) Ventricular fibrillation
D) Sinus tachycardia
Rationale: Ventricular tachycardia is characterized by the absence of P waves, wide QRS complexes (usually greater than 0.14 second), and a rate between 100 and 250 impulses per minute. The rhythm is usually regular.
A) Serum myoglobin level
B) Creatinine kinase (CK)
C) White blood cell count (WBC)
D) Troponin T levels
Rationale: CK-MB elevates 4-6 hours after tissue necrosis. Troponin levels rise 6-8 hours after the infarct (tissue necrosis) but also can occur with other types of tissue damage. Myoglobin also elevates, but to a lesser degree. WBC levels elevate with an inflammatory response. Troponin levels are more elevated than are the other cardiac enzymes, are more specific to cardiac tissue, and rise 6-8 hours after the infarct (tissue necrosis).
A) Reflects electrical impulse beginning at the SA node
B) Indicated electrical impulse beginning at the AV node
C) Reflects atrial muscle depolarization
D) Identifies ventricular muscle depolarization
E) Has duration of normally 0.11 seconds or less.
C) Reflects atrial muscle depolarization
E) Has duration of normally 0.11 seconds or less.
Rationale: In a client who has had an ECG, the P wave represents the activation of the electrical impulse in the SA node, which is then transmitted to the AV node. In addition, the P wave represents atrial muscle depolarization, not ventricular depolarization. The normal duration of the P wave is 0.11 seconds or less in duration and 2.5 mm or more in height.
A client is having frequent premature ventricular contractions. A nurse would place priority on assessment of which of the following items?
A ) Blood pressure and peripheral perfusion
B ) Sensation of palpitations
C ) Causative factors such as caffeine
D ) Precipitating factors such as infection
Answer:
A) B/P and peripheral perfusion
Rationale: Premature ventricular contractions can cause hemodynamic compromise. The shortened ventricular filling time with the ectopic beats leads to decreased stroke volume and, if frequent enough, to decreased cardiac output. The client may be asymptomatic or may feel palpitations. PVCs can be caused by cardiac disorders or by any number of physiological stressors, such as infection, illness, surgery, or trauma, and by the intake of caffeine, alcohol, or nicotine.
A) Angiotensin-converting enzyme (ACE) inhibitor
B) Beta-adrenergic blocker
C) Alpha adrenergic antagonist
D) Rosiglitazone (Avandia)
Rationale: Thiazolidinediones, like rosiglitazone (Avandia), are glucose-reducing drugs that are prescribed for persons with type 2 diabetes mellitus. ACE inhibitors, such as Lisinopril, are first-line drugs used to treat CHF. Propranolol (Inderal), a beta blocker, has remained one of the most widely used beta-blocking drugs. It blocks both beta1 and beta2 receptors in various organs, resulting in reduction of heart rate and the force of contraction, and suppresses impulse conduction through the AV node, all of which slows the progression of the disease process. Carvedilol (Coreg) is another beta-adrenergic blocker used to treat heart failure.
A) Hypotension and dizziness
B) Nausea and vomiting
C) Hypertension and headache
D) Flat neck veins
Rationale: The client with uncontrolled atrial fibrillation with a ventricular rate more than 150 beats a minute is at risk for low cardiac output because of loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins.
A) An absent P wave
B) An abnormal Q wave
C) T-wave inversion D) ST segment elevation
Rationale: A: An absent P wave is not part of the classic changes seen in an ECG result. B: An abnormal Q wave is an indication of MI. C: T-wave inversion is a classic ECG change in a patient with MI. D: ST segment elevation is an indication of MI.
Decreased variability in the FHR tracing can be caused by; SELECT ALL THAT APPLY :
a. acidosis
b. CNS depressants
c. fetal stimulation
d. hypoxia
a. acidosis
b. CNS depressants
d. Hypoxia
A newly licensed nurse and the charge nurse are reviewing a FHR tracing of a client in active labor. Which of the following should the nurse recognize as being associated with fetal hypoxia? SELECT ALL THAT APPLY
a. fetal bradycardia
b. fetal tachycardia
c. absence of variability
d. early decelerations
e. late decelerations
Answers:
a. fetal bradycardia
b. fetal tachycardia
c. absence of variability
e. late decelerations
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
Rationale: A: Stage I refer to a patient who reports no symptoms of heart failure at rest but becomes symptomatic with increased physical activity.
B: Stage II refers to a patient who reports presence of symptoms with increased physical activities.
C: Stage III refers to a patient who reports presence of symptoms with minimal physical activity.
D: Stage IV refers to a patient who reports presence of symptoms even during at rest.
A) Breathe deeply, regularly, and easily.
B) Inhale deeply and cough forcefully every 1 to 3 seconds.
C) Lie down flat in bed
D) Remove any metal jewelry
Rationale: Cough cardiopulmonary resuscitation (CPR) sometimes is used in the client with unstable ventricular tachycardia. The nurse tells the client to use cough CPR, if prescribed, by inhaling deeply and coughing forcefully every 1 to 3 seconds. Cough CPR may terminate the dysrhythmia or sustain the cerebral and coronary circulation for a short time until other measures can be implemented.
A) A blockage in the left coronary artery causes the least amount of damage to the heart muscle.
B) Left coronary artery blockages can cause anterior wall death which affects the left ventricle.
C) Left coronary artery blockage can cause posterior wall death which affects the right ventricle.
D) The left anterior descending artery is least likely to be affected by coronary artery disease.
Rationale: The LCA (if blocked) can cause the MOST amount of damage to the heart muscle. It affects the ANTERIOR part of the heart which affects the LEFT ventricle. The left descending artery is MOST likely to be affected by coronary artery disease.
A) Ineffective tissue perfusion related to decreased peripheral blood flow secondary to decreased cardiac output.
B) Activity intolerance related to increased cardiac output.
C) Decreased cardiac output related to structural and functional changes.
D) Impaired gas exchange related to decreased sympathetic nervous system activity.
C) Decreased cardiac output related to structural and functional changes.
HF is a result of structural and functional abnormalities of the heart tissue muscle. The heart muscle becomes weak and does not adequately pump the blood out of the chambers. As a result, blood pools in the left ventricle and backs up into the left atrium, and eventually into the lungs. Therefore, greater amounts of blood remain in the ventricle after contraction thereby decreasing cardiac output. In addition, this pooling leads to thrombus formation and ineffective tissue perfusion because of the decrease in blood flow to the other organs and tissues of the body. Typically, these clients have an ejection fraction of less than 50% and poorly tolerate activity. Activity intolerance is related to a decrease, not increase, in cardiac output. Gas exchange is impaired. However, the decrease in cardiac output triggers compensatory mechanisms, such as an increase in sympathetic nervous system activity.