Hemodynamic Monitoring/cardiac dysrhythmias (VFIB, Vtach, paced)
The nurse is caring for a client who has just had implantation of an automatic internal cardioverter-defibrillator. Which assessment is the nursing priority?
1.Anxiety level of the client and family
2.Activation status and settings of the device
3.Presence of Medic Alert card for the client to carry
4.Knowledge of restrictions on post discharge physical activity
The nurse who cares for this post procedural patient must assess device settings as priority, similar to a permanent pacemaker.
-Is the device activated?
-the heart rate cutoff above which it will fire
-number of shocks it is programmed to deliver
A client with a history of type 2 diabetes is admitted to the hospital with chest pain and scheduled for a cardiac catheterization. Which medication would need to be held for 24 hours before the procedure and for 48 hours after the procedure?
1. Glipizide
2. Metformin
3.Repaglinide
4.Regular insulin
Metformin (in addition to contrast affects kidney function and may put client into lactic acidosis)
What nursing diagnosis should the nurse expect to include when planning care for a patient with cardiomyopathy?
1)Pain, Chronic
2)Fluid Volume, Deficit
3)Gas exchange, impaired
4)Cardiac output, decreased
Decreased cardiac output
The nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable. How would the nurse interpret the client's neurovascular status?
1.)The neurovascular status is expected because of increased blood flow through the leg
2)The neurovascular status is moderately impaired, and the surgeon needs to be called
3)The neurovascular status is slightly deteriorating and needs to be monitored for another hour.
4) The neurovascular status shows adequate arterial flow, but venous complications are arising.
Warmth, redness, edema are expected outcomes in the surgical extremity due to increased blood flow.
Venous complications from immobilization take longer than 4 hours
pedal pulse unchanged since admission, redness due to new blood flow and edema from sudden change in pressure in the blood vessels.
A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats per minute. The PR interval is 0.14 sec, the QRS complex measure 0.08, and the PP and RR intervals are regular. How would the nurse interpret this rhythm?
1) Sinus tachycardia
2)Sinus bradycardia
3)sinus dysrhythmia
4)Normal sinus rhythm
sinus tachycardia
The nurse is assisting to defibrillate a client in ventricular fibrillation. Which intervention is a priority after placing pads on the client.
1.) Ensure the client has been intubated
2.) Set the defibrillator to "synchronize" mode
3.) Administer an amiodarone bolus
4.) Confirm the cardiac rhythm
Defib, vfib=priority intervention. No underlying heart rhythm to synchronize. Will be pulseless. The client will receive CPR while being hooked up to the defibrillator. Do not delay defib to adm amiodarone. A rhythm will need to be checked b/f a shock is delivered.
The nurse in a medical unit is caring for a client with heart failure. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles. The nurse immediately asks another nurse to contact the hospitalist and prepares to implement which priorities? Select all that apply.
1. Administer oxygen
2.inserting a foley cathetor
3.adminstering furosemide
4.Administering morphine sulfate intravenously
5.Transport the client to coronary care unit
6. Placing the client in low fowler's side lying position.
1,2,3,4
Pulmonary edema
High fowler to ease work of breathing
A foley to measure output
IV morphine reduces preload, anxiety, reduces work of breathing
Which circulatory therapy is used to treat cardiomyopathies?
1) surgical remodeling
2)Left ventricular assist device (LVAD)
3)Pacemaker
4)Cardiac transplantation
LVAD can support cardiac output prior to heart transplant, The device helps the left side of the heart to maintain perfusion to the rest of the circulatory system.
A pacemaker is used to control life threatening dysrhythmias or help maintain a stable heart rhythm.
Surgical ventricular remodeling is an alternative to transplantation, which is the definitive treatment for dilated cardiomyopathy.
During an assessment of a patient's abdomen, a pulsating abdominal mass is noted by the healthcare provider. Which of the following shoulder be the provider's next action?
1) Ask patient to perform Valsalva maneuver
2) Obtain a bladder scan
3) Measure the abdominal circumference
4) Assess femoral pulses
4
pulsating mass may be an abdominal aneurysm, must check degree of circulatory compromise
The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 seconds. and QRS complexes measures 0.06 seconds. The overall heart rate is 64 beats per minute. Which action would the nurse take?
1.) Check vital signs
2.Check laboratory test results
3. Monitor for any rhythm change
4.Notify the hospitalist
This is NSR, PR=0.12-0.20sec and QRS=0.04-.10sec
continue to monitor
A client in sinus bradycardia, with a heart rate of 45 beats per minute and blood pressure of 82/60 mmHG, reports dizziness. Which intervention would the nurse anticipate will be prescribed?
1.Administer digoxin
2.Defibrillate the client
3.Continue to monitor the client
4.Prepare for transcutaneous pacing
Prepare for transcutaneous pacing
A client with myocardial infarction suddenly becomes tachycardic, shows signs of air hunger, and begins coughing frothy, pink tinged sputum. Which finding would the nurse anticipate when auscultating the client's breath sounds?
1. Stridor
2.Crackles
3.Scattered rhonchi
4.Diminshed breath sounds
Crackles are lung sounds associated with pulmonary edema
Name 2 causes of endocarditis
bacteria in the blood stream (bacteremia)
-dirty needles
-infection from dental procedure/sx of mouth or gums
congenital abnormalities (abnormal valve flap that allows bacteria to enter)
Faulty heart prosthetics
Untreated strep throat
Which of the following are signs of a rupturing AAA? Select all that apply
1) Increased BP
2)Decrease HCT
3) Low back pain
4) Decreased BP
B,C,D
Patient is losing blood, pain is a key sign of rupturing. During rupture, pain becomes constant.
A client's cardiac rhythm suddenly changes on the monitor. There are no P waves; instead, there are fibrillatory waves before each QRS complex. How would the nurse interpret the rhythm?
1.) atrial fibrillation
2.) Sinus tachycardia
3.) Ventricular fibrillation
4.) Ventricular tachycardia
Atrial fibrillation= loss of p waves and fibrillatory waves before each QRS complex. The atria quiver can lead to thrombus formation.
A client is wearing a continuous cardiac monitor, which begins to sound its alarm. The nurse sees no electrocardiographic complexes on the screen. What is the priority nursing action?
1. Call a code
2. Check the client's status
3.Call the Hospitalist
4.Document the lack of complexes
Nurse must immediately check client's status to determine if ECG is accurate and emergent intervention is necessary.
A client with myocardial infarction is developing cardiogenic shock. Which potential condition would the nurse anticipate and monitor the client for to detect cardiogenic shock?
1.Pulsus paradoxus
2.Ventricular dysrhythmias
3.Rising diastolic blood pressure
4.Falling central venous pressure
Ischemia of MI makes the myocardium irritable, at risk for dysrhythmias. Ventricular dysrhythmias occur as a result of decreased oxygenation and severe damage to greater than 40% of the myocardium.
classic signs of cardiogenic shock are low BP, tachycardia
CVP rises as the backward effects of severe left ventricular dysfunction become apparent. Pulsus paradoxus (BP decrease when breathing in) is a finding associated with cardiac tamponade. Other associated findings include Beck's Triad faint heart sounds, jugular distension, and hypotension.
This is a common lung sound heard with pericarditis
pericardial rub (pericardium rubbing against the outer layer of the heart)
additional findings may include pulsus paradoxus
cardiac tamponade is a complication of undiagnosed pericarditis
common causes are infection, chest injury, kidney failure, radiation to the chest, heart surgery
What would be the treatment option of choice for an AAA that is 6 cm?
1) BP med
2)Thrombolytic agent
3)Crestor
d) Surgery
For aneurysms larger that 5.5cm, surgery is treatment of choice. If smaller, antihypertensive can lower pressure on aortic wall
The nurse is monitoring the cardiac monitor and notices that a client's rhythm suddenly changes. There are no P waves, the QRS complexes are wide, and the ventricular rate is regular but more than 140 beats per minute. The nurse determines that the client is experiencing which dysrhythmia?
1.Sinus Tachycardia
2.Ventricular fibrillation
3.Ventricular tachycardia
4.Premature ventricular contractions
Ventricular tachycardia is characterized by the absence of p waves, wide QRS >0.12 sec, rate 140-180
A client in Vfib is about to be defibrillated. Which energy level (in joules, J) would the nurse set on the monophasic defibrillator machine for the first delivery?
1. 50J
2. 120J
3. 200J
4. 360J
360J for monophasic defibrillation.
pro tip: Biphasic will be a smaller number
A client is diagnosed with an ST elevation myocardial infarction (STEMI) and is receiving tissue plasminogen activator (tpa), alteplase. Which is the priority nursing intervention?
1)Monitor for kidney failure
2)Monitor for psychosocial status
3)Monitor for signs of bleeding
4)Have heparin sodium available
TPA is thrombolytic: hemorrhage is the priority risk
A client with valvular heart disease who has a clot in the right atrium is receiving a heparin sodium infusion at 1000 units/hr and warfarin sodium 7.5mg at 1600 daily. The morning laboratory results are as follows aptt, 32 seconds; INR, 1.3. Which action would the nurse take based on the client's laboratory results?
1.) Collaborate with the hospitalist to discontinue the heparin infusion and administer the warfarin sodium as prescribed.
2.) Collaborate with the hospitalist to obtain a prescription to increase the heparin infusion and continue warfarin sodium as prescribed.
3.) Collaborate with the hospitalist to withhold warfarin sodium since the client is receiving a heparin infusion and the aPTT is within the therapeutic range.
4.) Collaborate with the hospitalist to continue the heparin infusion at the same rate and to discuss use of dabigatran etexilate in place of warfarin sodium.
warfarin therapeutic value is 2-3, until therapeutic range achieved, maintain continuous heparin drip with aPTT 60-80.
correct answer is 2
What are risk factors for aortic aneurysm?
-male
-smoking
-family history
-congenital weakness
-hypertension
A client has frequent bursts of ventricular tachycardia on the cardiac monitor. Which factor is the highest priority with regard to this dysrhythmia?
1)It can develop into v. fib at any time
2)It is almost impossible to convert to a normal rhythm
3) It is uncomfortable for the client, giving a sense of impending doom
4) It produces a high cardiac output with cerebral and myocardial ischemia
It can develop into v.fib/cardiac arrest at any time
treat v tach with antidysrhythmic medications/conversion (if awake)
or
defib with loss of consciousness