CARDIOVASCULAR

ANGINA

100

A client is admitted to the ED with complaints of severe, radiating chest pain. The client is extremely restless, frightened, and dyspneic. Immediate admission prescriptions include O2 by NC (4L/min), troponin, creatinine phosphokinase, and isoenzymes blood levels, a chest X-Ray, and a 12-Lead ECG. Which action the nurse take first? a) Obtain the 12-Lead ECG b) Draw the blood specimens c) Apply the oxygen to the client 4) Call radiology to schedule the chest X-Ray

What is c) Apply the oxygen to the client The first action would be to apply the oxygen because the client can be experiencing myocardial ischemia. The ECG can provide evidence of cardiac damage and the location of myocardial ischemia. However, oxygen is the priority to prevent further cardiac damage. Drawing the labs would be after the oxygen administration and before or after the ECG. Having the X-Ray would not influence immediate treatment, but it would show cardiac enlargement.

200

A client diagnosed with angina pectoris complains of chest pain while ambulating in the hallway. Which action should the nurse implement first? A. Support the client to a sitting position. B. Ask the client to walk slowly back to the room. C. Administer a sublingual nitroglycerin tablet. D. Provide oxygen via nasal cannula.

What is A? The nurse should safely assist the client to a resting position (A) and then perform (C and D). The client must cease all activity immediately, which will decrease the oxygen requirement of the myocardial muscle. After these interventions are implemented, the client can be escorted back to the room via wheelchair or stretcher (B).

300

Older clients experiencing anginal pain with complaints of fatigue or weakness usually are medicated with which of the following types of medication? A. Sublingual nitroglycerin B. Cardiac glycosides C. HMG-CoA reductase inhibitors D. Morphine sulfate

What is A? Sublingual nitroglycerin 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

400

A client newly diagnosed with angina pectoris has taken 2 sublingual nitroglycerin tablets for chest pain. The chest pain is relieved, but the client complains of a headache. The nurse interprets that this is a symptom that most likely represents: A. An early sign of medication tolerance B. An allergic reaction to the nitroglycerin C. An expected side effect of the medication D. A warning sign that the medication should not be used again

What is C? Headache id a frequent sign of nitroglycerin, because of the vasodilating action of the medication. It usually diminished in frequency as the client becomes accustomed to the medication and is effectively treated with acetaminophen (Tylenol). The other options are incorrect.

500

A client has just been admitted to the emergency department with chest pain. Serum enzyme levels are drawn and the results indicate an elevated serum creatinine kinase (CK-MB isoenzyme, troponin T, and Troponin I. The nurse concludes that these results are compatible with: A. Stable angina B. Unstable angina C. Prinzmetal's angina D. New-onset MI

What is D? CKMB isoenzyme is a sensitive indicator of MI. Levels begin to rise 3-6hrs after the onset of chest pain, peak at approximately 24hrs and return to normal in about 3 days. Troponin is a regulatory protein found in striated muscle (skeletal and myocardial). Increased amounts of troponins are released into the bloodstream when an infarction causes damage to the myocardium. Therefore the client's results are compatible with new onset MI. A,B, and C refer to angina. These levels would not be elevated in angina.

MYOCARDIAL INFARCTION

100

A client is admitted to the hospital with a myocardial infarction and is not experiencing chest pain at this time. The nurse reviews the ECG rhythm strip and notes that the PR intervals are 0.16seconds. The nurse determines that this measurement indicates: a) A normal finding b) An abnormal finding c) First-degree atrioventricular block d) An impending reinfarction

What is: a) A normal finding The PR interval represents the time it takes for the cardiac impulse to spread from the atria to the ventricles. The normal PRI range= 0.12-0.20 seconds. Answers b, c, and d are comparable and alike and all indicate abnormal findings.

200

A client with myocardial infarction 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

What is B? Crackles Pulmonary edema is characterized by extreme breathlessness, dyspnea, air hunger, and the 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.

300

The nurse is caring for a patient after suffering from a myocardial infarction. Which of the following is the most common complication of a myocardial infarction? A. Cardiac arrhythmias B. Valvular disease C. Cardiogenic shock D. Heart failure

What is A? Cardiac arrhythmias are the most common complication associated with M.I. They frequently cause disability and death. Heart failure and cardiogenic shock are known complications of M.I, but they are not as common as arrhythmias. Valvular disease is not a known complication of MI.

400

The nurse is caring for a client who is 1 day post–acute myocardial infarction. The client is receiving oxygen at 2 L/min via nasal cannula and has a peripheral saline lock. The nurse notes that the client is having eight premature ventricular contractions (PVCs) per minute. Which intervention should the nurse implement first? A. Obtain an IV pump for antiarrhythmic infusion. B. Increase the client's oxygen flow rate. C. Prepare for immediate countershock. D. Gather equipment for endotracheal intubation.

What is B? Increasing the oxygen flow rate (B) provides more oxygen to the client's myocardium and may decrease myocardial irritability as manifested by the frequent PVCs. (A) can be delegated and is a lower priority action than (B). Defibrillation may eventually be necessary, but (C) is not the immediate treatment for frequent PVCs. (D) may become necessary if the client stops breathing, but is not indicated at this time.

500

A client recovering from acute MI will be discharged in 1 day. Which client action on the evening before discharge suggests that the client is in denial phase? A. Request a sedative for sleep at 10:00PM B. Express a hesitancy to leave the hospital C. Consumes 25% of foods and fluids given for supper D. Walks up and down 3 flights of stairs unsupervised

What is D? Ignoring activity limitations and avoiding lifestyle changes are signs of the denial stage. Walking 3 flights of stairs should be supervised activity during this stage of the recovery process. A) is an appropriate action. B) is a manifestation of anxiety and fear rather than denial. C) is a manifestation of depression rather than denial.

HYPERTENSION

100

A client with hypertension has been receiving ramipril (Altace), 5 mg PO, daily for 2 weeks and is scheduled to receive a dose at 0900. At 0830, the client's blood pressure is 120/70 mm Hg. Which action should the nurse take? A. Administer the prescribed dose at the scheduled time. B. Hold the dose and contact the health care provider. C. Hold the dose and recheck the blood pressure in 1 hour. D. Check the health care provider's prescription to clarify dose.

What is A? The client's blood pressure is within normal limits, indicating that the ramipril, an antihypertensive, is having the desired effect and should be administered (A). (B and C) would be appropriate if the client's blood pressure was excessively low (<100 mm Hg systolic) or if the client were exhibiting signs of hypotension such as dizziness. This prescribed dose is within the normal dosage range, as defined by the manufacturer; therefore, (D) is not necessary.

200

A client who is receiving an angiotensin-converting enzyme (ACE) inhibitor for hypertension calls the clinic and reports the recent onset of a cough to the nurse. Which action should the nurse implement? What is D. A. Advise the client to come to the clinic immediately for further assessment. B. Instruct the client to discontinue use of the drug and to make an appointment at the clinic. C. Suggest that the client learn to accept the cough as a side effect to a necessary prescription. D. Encourage the client to keep taking the drug until seen by the health care provider.

Coughing is a common side effect of ACE inhibitors and is not an indication to discontinue the medication (D). Immediate evaluation is not needed (A). Antihypertensive medications should not be stopped abruptly (B) because rebound hypertension may occur. (C) is demeaning because the cough may be very disruptive to the client, and other antihypertensive medications may produce the desired effect without the adverse effect.

300

A nurse caring for a patient with hypertension receiving torsemide (Demadex) 5mg orally daily. Which of the following would indicate to the nurse that the client might be experiencing a side effect to the medication? A. A chloride level of 98 mEq/L B. A sodium level of 135 mEq/L C. A potassium level of 3.1 mEq/L D. A blood urea nitrogen (BUN) of 15mg/dL

What is C? Torsemide is a loop diuretic. The medication can produce acute, profound water loss, volume and electrolyte depletion, dehydration, decreased blood volume, and circulatory collapse. C) is the only option that indicates electrolyte depletion because the normal potassium level is 98 to 107 mEq/L. The normal sodium is 135-145 mEq/L/ The normal BUN is 5-20 mg/dL.

400

A nurse is assessing a 39-yr old Caucasian client. The client has a BP of 152/92 at rest, a total cholesterol level of 190mg/dL, and a fasting blood glucose level of 110 mg/dL. The nurse would place priority on which risk factor for coronary heart disease (CHD) in this client? A. Age B. Hypertension C. Hyperlipidemia D. Glucose Intolerance

What is B? HTN, cigarette smoking, and hyperlipidemia are major risk factors for CHD. Glucose intolerance, obesity, and response to stress are also contributing factors. An age of >40y.o is a non modifiable risk factor. A cholesterol level of >190 mg/dL and a blood glucose level of 110 mg/dL are within normal range. The nurse places priority on major risk factors that need modification.

500

A nurse is caring for a client experiencing hypertensive crisis. The physician tells the nurse that medication will be prescribed to help both preload and afterload. The nurse anticipates that the physician will prescribe which medication? A. Morphine sulfate B. Digoxin (Lanoxin) C. Furosemide (Lasix) D. Nitroprusside sodium

What is D? IV nitroprusside is a potent vasodilator that reduces both preload and afterload. Digoxin is a cardiac glycoside that increases cardiac contractility. Morphine sulfate is an opioid analgesic. Furosemide is a loop diuretic and can reduce preload by enhancing the renal excretion of sodium water, which reduces circulating blood volume.

DYSRHYTHMIA

100

Chemical cardioversion is prescribed for the client with atrial fibrillation. The nurse who is assisting in preparing the client would expect that which medication specific for chemical cardioversion will be needed? a) Nitroglycerin b) Nifedipine (Procardia) c) Lidocaine (Xylocaine) d) Amiodorone (Cordarone)

What is d) Amiodorone (Cordarone)? Amiodorone is an antidysrhythmic that is useful in restoring normal sinus rhythm for the client experiencing atrial fibrillation. Both nitroglycerin and nifedipine are vasodilators. Lidocaine is used for control of ventricular dyrhythmias.

200

The nurse is monitoring a pt who has received antidysrhythmic therapy for the treatment of PVC's. The nurse would determine this therapy as being less than optimal if the client's PVC's continued to: a) Occur in pairs b) Be unifocal in appearance c) Be fewer than 6 per minute d) Fall after the end of the T wave

What is a) Occur in pairs PVC's are considered dangerous when they are frequent (>6/min), occur in pairs or couplets, are multifocal (multiform), or fall on the T wave. Note the strategic words "less than optimal" meaning the answer that identifies ineffective treatment.

300

A client is having premature ventricular contractions. A nurse would place priority on assessment of which of the following? A. Sensation of palpitations B. Causative factors, such as caffeine C. Precipitating factors, such as infection D. Blood pressure and oxygen saturation

What is D? PVC's can cause hemodynamic compromise. The shortened ventricular filling time with the ectopic beat leads to decreased stroke volume and if frequent enough, to decrease C.O. The client may be asymptomatic or may feel palpitations. PVC's can be caused by cardiac disorders, states of hypoxemia, or by any number of physiological stressors, such as infection, illness, surgery, or trauma, and by intake of caffeine, nicotine, or alcohol.

400

The nurse observes ventricular fibrillation on telemetry and, on entering the client's bathroom, finds the client unconscious on the floor. Which intervention should the nurse implement first? A. Administer an antidysrhythmic medication. B. Start cardiopulmonary resuscitation. C. Defibrillate the client at 200 J. D. Assess the client's pulse oximetry.

What is B? Ventricular fibrillation is a life-threatening dysrhythmia, and CPR should be started immediately (B). (A and C) are appropriate, but CPR is the priority action. The client is dying, and (D) does not address the seriousness of this situation.

500

When developing a discharge teaching plan for a client after the insertion of a permanent pacemaker, the nurse writes a goal of "The client will verbalize symptoms of pacemaker failure." Which behavior indicates that the goal has been met? A. The client demonstrates the procedures to change the rate of the pacemaker using a magnet. B. The client carries a card in his wallet stating the type and serial number of the pacemaker. C. The client tells the nurse that it is important to report redness and tenderness at the insertion site. D. The client states that changes in the pulse and feelings of dizziness are significant changes.

What is D? Changes in pulse rate and/or rhythm may indicate pacer failure. Feelings of dizziness may be caused by a decreased heart rate, leading to decreased cardiac output (D). The rate of a pacemaker is not changed by a client, although the client may be familiar with this procedure as explained by his health care provider (A). (B) is an important step in preparing the client for discharge but does not demonstrate knowledge of the symptoms of pacer failure. (C) indicates symptoms of possible incisional infection or irritation but do not indicate pacer failure.

HEART FAILURE

100

The nurse is giving a client with heart failure home care instructions for use after hospital discharge. The client interrupts, saying, "Whats the use? I'll never remember all of this, and I'll probably die anyway!" The nurse interprets that the client's response is most likely the result of: A. Anger about the new medical regimen B. The teaching strategies used C. Insufficient financial resources to pay for the medications D. Anxiety about the inability to manage the disease process at home

What is D? Anxiety and few often develop after heart failure, and they can further tax the failing heart. The client;s statement is made in the middle of receiving self-care instructions. There is no evidence to support A, B, or C.

200

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.

What is Answer: 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.

300

A client with congestive heart failure and atrial fibrillation develops ventricular ectopy with a pattern of 8 ectopic beats/min. Which action should the nurse take based on this observation? A. Assess for bilateral jugular vein distention. B. Increase oxygen flow via nasal cannula. C. Administer PRN furosemide (Lasix). D. Auscultate for a pleural friction rub.

What is B? This client should have the oxygen flow immediately increased to promote oxygenation of the myocardium (B). Ventricular ectopy, characterized by multiple PVCs, is often caused by myocardial ischemia exacerbated by hypokalemia. The nurse would expect the client in congestive heart failure to have some degree of (A), which does not exacerbate the ectopy. (C) could create a more severe hypokalemia, which could increase the ectopy. The client is not exhibiting signs of (D).

400

The nurse assesses a client who has been prescribed furosemide (Lasix) for cardiac disease. Which electrocardiographic change would be a concern for a client taking a diuretic? A. Tall, spiked T waves B. A prolonged QT interval C. A widening QRS complex D. Presence of a U wave

What is D? A U wave (D) is a positive deflection following the T wave and is often present with hypokalemia (low potassium level). (A, B, and C) are all signs of hyperkalemia.

500

During assessment of a client in the intensive care unit, the nurse notes that the client's breath sounds are clear on auscultation, but jugular vein distention and muffled heart sounds are present. Which intervention should the nurse implement? A. Prepare the client for a pericardial tap. B. Administer intravenous furosemide (Lasix). C. Assist the client to cough and breathe deeply. D. Instruct the client to restrict the oral fluid intake.

What is A? The client is exhibiting symptoms of cardiac tamponade, a collection of fluid in the pericardial sac that results in a reduction in cardiac output, which is a potentially fatal complication of pericarditis. Treatment for tamponade is a pericardial tap (A). Lasix IV is not indicated for treatment of pericarditis (B). Because the client's breath sounds are clear, (C) is not a priority. Fluids are frequently increased (D) in the initial treatment of tamponade to compensate for the decrease in cardiac output, but this is not the same priority as (A).