Cardiac Flashcards
The nurse monitors a client’s EKG strip and notes coupled premature ventricular contractions greater than 10 per minute. The nurse should expect to administer which of the following?
1. Atropine sulfate (Atropine) IV. 2. Isoproterenol (Isuprel) IV. 3. Verapamil (Calan) IV. 4. Lidocaine hydrochloride (Xylocaine) IV.
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Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired?
(1) antidysrhythmic, used for bradycardia
(2) antidysrhythmic, used for heart block, ventricular dysrhythmias
(3) antihypertensive, calcium-channel blocker
(4) correct—lidocaine is the drug of choice for frequent premature ventricular contractions (PVC) occurring in excess of 6 to 10 per minute; for coupled PVCs or for a consecutive series of PVCs that may result in ventricular tachycardia
An older woman comes to the outpatient clinic because she has not been feeling well for several days. During the admission interview, the nurse learns that the client has a history of heart failure (HF), is on a low-sodium diet, and has been taking chlorothiazide (Diuril) 500 mg PO daily for 6 months. Diagnostic tests indicate sodium 127 mEq/L, potassium 3.8 mEq/L, glucose 110 mg/dL, and normal chest x-ray. It is MOST important for the nurse to assess for which of the following?
1. Sticky mucous membranes; decreased urinary output; and firm, rubbery tissues. 2. Cool, moist skin; fine hand tremors; and mental confusion. 3. Headache, apprehension, and lethargy. 4. Shortness of breath, chest pain, and anxiety.
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Strategy: Determine the significance of each answer choice.
(1) symptoms of hypernatremia, along with restlessness, weakness, coma, tachycardia, flushed skin, oliguria, fever
(2) symptoms of hypoglycemia, normal blood sugar 70–110 mg/dL
(3) correct—symptoms of hyponatremia along with muscle twitching, convulsions, diarrhea, fingerprinting of skin
(4) symptoms of CHF, chest x-ray clear, no other information provided
If a client develops cor pulmonale (right-sided heart failure), the nurse expects to observe which of the following?
1. Increased respiration with exertion. 2. Cough producing large amount of thick, yellow mucus. 3. Peripheral edema and anorexia. 4. Twitching of extremities.
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Strategy: Determine how each answer choice relates to cor pulmonale.
(1) common assessment finding of the patient with chronic lung disease
(2) describes a complication of pneumonia
(3) correct—right-sided heart failure is manifested by congestion of the venous system, resulting in peripheral edema; also, there is congestion of the gastric veins, resulting in anorexia and eventual development of ascites
(4) is not seen with this client
A client has a history of oliguria, hypertension, and peripheral edema. Current lab values are BUN 25 and K+ 4.0 mEq/L. The nurse should restrict which of the following in the client’s diet?
1. Protein. 2. Fats. 3. Carbohydrates. 4. Magnesium.
Strategy: Determine which system is involved and then determine which nutrients require restriction.
(1) correct—decreased production of urea nitrogen can be achieved by restricting protein; metabolic wastes cannot be excreted by the kidneys
(2) decreases the nonprotein nitrogen production; these foods are encouraged
(3) decreases the nonprotein nitrogen production; these foods are encouraged
(4) should not be restricted
After a client develops left-sided hemiparesis from a cerebral vascular accident (CVA), the nurse notes a decrease in muscle tone. The nurse determines which of the following nursing diagnoses is priority?
1. Alteration in mobility related to paralysis. 2. Alteration in skin integrity related to decrease in tissue oxygenation. 3. Alteration in skin integrity related to immobility. 4. Alteration in communication related to decrease in thought processes.
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Strategy: Think about each answer choice.
(1) not a priority
(2) correct—leading cause of skin breakdown is a decrease in tissue perfusion
(3) not a priority
(4) would be more relevant to right-sided hemiparesis
The nurse plans care for a client on bed rest. To promote evening rest and sleep for this client, it is MOST important for the nurse to take which of the following actions?
1. Provide privacy. 2. Give back rubs at bedtime. 3. Assist with a bath every day. 4. Encourage daytime activities.
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Strategy: Answers are implementations. Determine the outcome of each answer choice. Is it desired?
(1) excessive privacy can limit sensory input
(2) will help client to relax but is not most important
(3) should encourage client to do as much of his care as he can to maintain independence
(4) correct—provides relief from tension, ensures client naps less during the day, helps client relax
A client is being discharged with sublingual nitroglycerin (Nitrostat). The client should be cautioned by the nurse to
1. take the medication 5 minutes after the pain has started. 2. stop taking the medication if a stinging sensation is absent. 3. take the medication on an empty stomach. 4. avoid abrupt changes in posture.
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Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired?
(1) should be taken immediately when pain is felt
(2) presence or absence of a stinging sensation is not indicative of the effect of the drug
(3) should be taken when pain is experienced
(4) correct—nitroglycerin can cause hypotension; client should avoid changing positions quickly to decrease the chances of falling
A client is in cardiogenic shock after a myocardial infarction (MI). Which of the following is a correctly stated nursing diagnosis for the client?
1. Activity intolerance: related to impaired oxygen transport. 2. Altered tissue perfusion related to decreased heart-pumping action. 3. Altered cardiac output related to cardiac ischemia. 4. Potential fluid volume deficit related to decreased intake.
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Strategy: Think about each answer choice.
(1) not best
(2) correct—correctly stated, appropriate nursing diagnosis
(3) altered cardiac output is not a commonly accepted nursing diagnosis
(4) not appropriate for this client
The physician orders sucralfate (Carafate) 1 g PO bid for a client taking digoxin (Lanoxin) 0.25 mg daily. The client asks the nurse if both pills can be taken together at breakfast so that the client doesn’t forget to take them. The nurse should advise the client to take which of the following actions?
1. Take the Carafate and Lanoxin before breakfast. 2. Take the Lanoxin 1 hour before breakfast and the Carafate 1 hour after breakfast. 3. Take the Carafate 1 hour before breakfast and the Lanoxin 1 hour after breakfast. 4. Take the Carafate and the Lanoxin after breakfast.
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Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired?
(1) Carafate forms a barrier on the gastrointestinal mucosa, would decrease absorption of other medications, separate by 2 hours
(2) Carafate best results on empty stomach
(3) correct—Carafate best results on empty stomach, medications should be separated by 2 hours for maximum absorption
(4) Carafate best results on empty stomach, medications should be separated by 2 hours for maximum absorption
A client is scheduled for a cardiac catheterization and the nurse teaches the client about the procedure. Which of the following statements, if made by the client to the nurse, indicates an understanding of the teaching?
1. "I'm going to feel cold during the procedure." 2. "I can get up and walk to the bathroom immediately after the procedure." 3. "The nurse will be checking my foot pulses after the procedure." 4. "I won't be able to eat for 24 hours before the procedure."
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Strategy: “Understands teaching” indicates that you are looking for a true statement.
(1) may feel burning sensation when dye injected
(2) on bedrest 8 to 12 h after procedure with pressure dressing applied over catheter insertion site
(3) correct—peripheral pulses checked every 15 min for 1 h, then every 30 min for 2 h, then every 4 h
(4) NPO midnight before procedure
The client had an aortic aneurysm resection 2 days ago. A complete blood count reveals a decreased red blood cell count. The nursing assessment is MOST likely to reveal which of the following?
1. Fatigue, pallor, and exertional dyspnea. 2. Nausea, vomiting, and diarrhea. 3. Vertigo, dizziness, and shortness of breath. 4. Malaise, flushing, and tachycardia.
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Strategy: Remember the “comma, comma, and” rule. Each part of the answer choice must be correct for the answer to be correct.
(1) correct—characteristic of most types of anemia; result of tissue hypoxia secondary to inadequate red blood cells
(2) indicates GI problems
(3) vertigo not an indication of anemia
(4) flushing not an indication of anemia
The nurse assesses a pregnant client with a diagnosis of mitral stenosis and heart failure (HF). The nurse identifies that which of the following in the client’s history has a direct correlation with the current problem?
1. History of rheumatic fever 4 years ago. 2. Presence of ventricular septal defect as an infant. 3. Heart disease in both the maternal and the paternal families. 4. Persistent ear infections and mastoiditis as a child.
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Strategy: Think about each answer choice.
(1) correct—most common cause of mitral valve problems is a history of rheumatic fever with a subsequent complication of carditis, which affects the valve
(2) does not contribute to mitral valve disease
(3) does not contribute to mitral valve disease
(4) does not contribute to mitral valve disease
The nurse performs screening at the local senior citizens’ facility. The nurse is MOST concerned if which of the following is observed?
1. A 69-year-old man has a slightly elevated systolic blood pressure. 2. The nurse has difficulty palpating an apical pulse on a 74-year-old woman. 3. The nurse auscultates an S3 ventricular gallop on a 78-year-old woman. 4. An 81-year-old man has a temperature of 98.2°F (36.7°C).
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Strategy: Determine how each assessment relates to an older adult.
(1) usual finding for the older adult
(2) usual finding for the older adult
(3) correct—ventricular gallop is the earliest sign of HF
(4) may be normal in all age groups
An older client has an order for digoxin (Lanoxin) 0.25 mg PO daily. The nurse reviews the following information: apical pulse 68/min, respirations 16/min, plasma digoxin level 2 ng/mL. Which of the following actions by the nurse is BEST?
1. Give the medication on time. 2. Withhold the medication; notify the physician. 3. Administer epinephrine 1:1,000 stat. 4. Check the client's blood pressure.
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Strategy: Answers are a mix of assessments and implementations. Is the assessment appropriate? No. Determine the outcome of the implementations.
(1) medication should be withheld
(2) correct—therapeutic plasma level of digoxin is 0.5-2.0 ng/mL
(3) not a correct action
(4) assessment, does not address the issue of the elevated blood level of digoxin
The nurse cares for a client receiving atorvastatin (Lipitor). It is MOST important for the nurse to report which of the following client statements to the physician?
1. "I no longer drink grapefruit juice." 2. "I have my liver enzymes checked regularly." 3. "I take a daily multivitamin." 4. "I take propranolol (Inderal)."
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Strategy: Think about what the client’s words mean.
(1) appropriate action; grapefruit juice decreases the enzyme that breaks down atorvastatin
(2) appropriate action
(3) not contraindicated
(4) correct—propranolol decreases the effectiveness of atorvastatin
