CARDIAC Flashcards
A nurse is monitoring an infant with congenital heart disease closely for signs of heart failure. What should the nurse assess as an early sign of HF in infants? A/ Pallor B/ Cough C/ Tachycardia D/ Slow and Shallow Breathing
C/ Tachycardia
HF is the inability of the heart to effectively pump blood to meet oxygen and metabolic demand. Early signs include: Tachycardia Tachypnea Profuse Scalp Sweating Fatigue and irritability Sudden weight gain Respiratory distress
A cough may occur as a result of mucosal swelling and irritation, but not an early sign.
Pallor may also be noted, but is not an early sign.
The nurse reviews the lab results of a child suspected of having Rheumatic Fever. Knowing this, which lab result should the nurse study in confirming the diagnosis? A/ Immunoglobulin B/ RBC count C/ WBC count D/ Anti-steptolysin O titer
D/ Anti-steptolysin O titer
Rheumatic fever affects connective tissues of the heart, joints, skin, blood vessels, and CNS.
Evidence of a recent Streptococcal infection if confirmed by a positive Anti-steptolysin O titer.
All other options would not indicate this specific diagnosis.
The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin. Which statement made by the parent indicates the need for further instruction?
A/ “I will not mix the medication with food”
B/ “I will take my child’s pulse before administering the medication”
C/ “If more than one dose is missed, i will call the HCP”
D/ “If my child vomits after administration, I should repeat the dose”
D/ Emesis + repeat dose
Digoxin is a cardiac glycoside that makes more calcium available for contractile proteins; thereby resulting in increased cardiac output, increased force of contractions, decreased HR, and decreased AV conduction speed.
They should not repeat a dose after emesis. Digoxin toxicity is a dangerous and medical emergency
Options A/B/C are correct responses
The nurse is closely monitoring the intake and output of an infant with heart failure who is receiving diuretic therapy. The nurse should use which most appropriate method to assess the urine output?
A/ Weighing the diapers
B/ Inserting a foley Catheter
C/ Comparing intake with output
D/ Measuring the amount of water added to formula
A/ Weighing Diapers
HF is the inability of the heart to pump effectively to meet the demands of the body. The most appropriate method is the weigh diapers.
Comparing intake and output would not be accurate measure of urine output.
Measuring formula water dose not gain urinary output
Foley catheter may be most accurate, it places infant at the risk of infection and is not the most appropriate.
The clinic nurse reviews the record of a child just seen by a health care provider and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder? A/ Pallor B/ Hyperactivity C/ Exercise intolerance D/ Gastrointestinal Disturbances
C/ Exercise intolerance
Aortic stenosis is a narrowing or stricture of the aortic valve, causing resistance to blood flow in the left ventricle, decreased cardiac out, left ventricular hypertrophy, and pulmonary vascular congestion. This child will shows signs of exercise intolerance, chest pain, and dizziness when standing for long periods.
Pallor may be noted, but is not specific to this type of disorder alone.
B/D are not related
The nurse has provided home care instructions to the parents of a child who is being discharged after cardiac surgery. Which statement made by the parents indicates a need for further instructions?
A/ “A balance of rest and exercise is important.”
B/ “I can apply lotion or powder to the incision if it is itchy.”
C/ “Activities in which my child could fall need to be avoided for 2 to 4 weeks.”
D/ “Large crowds of people need to be avoided for at least 2 weeks after surgery.”
B/ Lotion & powder
Lotions and powders should not be applied if itchy of uncomfortable. These can irritate the skin and lead to skin breakdown and subsequent infection of the incision site.
All other options are okay postoperatively.
A child with rheumatic fever will be arriving in the nursing unit for admission. On admission assessment, the nurse should ask the parents which question to elicit assessment information specific to the development of rheumatic fever?
A/ “Has the child complained of back pain?”
B/ “Has the child complained of headaches?”
C/ “Has the child had any nausea or vomiting?”
D/ “Did the child have a sore throat or fever within the last 2 months?”
D/ Sick in last 2 months?
Rheumatic fever is an inflammatory autoimmune disease that affects the connective tissues of the heart, koints, skin, blood vessels, and CNS. It manifests characteristically 2-6 weeks after an untreated or partially treated group A Beta-hemolytic streptococcal infection of the upper respiratory tract.
All other options are unrelated to illness.
A health care provider has prescribed oxygen as needed for an infant with heart failure. In which situation should the nurse administer the oxygen to the infant?
A/ During sleep
B/ When changing the infant’s diapers
C/ When the mother is holding the infant
D/ When drawing blood for electrolyte level testing
D/ When drawing blood
Cyring exhausts the baby’s limited energy supply and increases the workload of the heart along with O2 demands. O2 should be administered during stressful periods
A client returns from a left heart catheterization. The right groin was used for catheter access. Which which location should the nurse palpate the distal pulse on this client? A/ Anterior to the right tibia B/ Dorsal surface of the right foot C/ Posterior to the right knee D/ Right mid-inguinal area
B/ Dorsal foot
When the left side of the heart is catheterized, the cannula enters an artery. While all the options are arteries on the right leg, the foot provides the most dorsal location. Blood may be actively pumping at other regions but be less present or absent at the most dorsal region (the foot).
A client is admitted with chest pain and kept overnight for stress testing in the morning. Prior to sending the client to the stress test, the nurse reviews the lab work for the client. The nurse should report an elevation of which lab value to the HCP prior to the test? A/ Cholesterol B/ Erythrocyte Sedimentation Rate C/ Prothrombin Time D/ Troponin
D/ Troponin
Elevated troponin levels indicated myocardial tissue damage and would be contraindicated in stress testing.
A client with chest pain is given IV nitroglycerin. Which assessment if of greatest concern for the nurse initiating the IV drip? A/ Serum K+ of 3.5mEq/L B/ Blood pressure 88/46 mmHg C/ ST elevation is present on the ECG D/ Heart rate is 61 bpm
B/ Blood pressure 88/46 mmHg
The client is hypotensive and nitroglycerin will greatly increase this affect.
Although an elevated ST is concerning, it could also be expected if the client is receiving nitro drip.
All other values are within normal ranges.
The nurse is caring for a client diagnosed with an anterior MI 2 days ago. Upon assessment, the nurse notes a systolic murmur at the apex. The nurse should first:
A/ Assess for changes in vital signs
B/ Draw arterial blood gases
C/ Evaluate heart sounds with client leaning forward
D/ Obtain a 12-lead ECG
A/ Assess for changes in vital signs
Obtaining Vitals will reflect the severity of the sudden drop in cardiac out:
Decrease in BP
Tachycardia
Tachypnea
Infarction of the papillary muscles is a potential complication post-MI, and causes ineffective Mitral valve operation during systole. Mitral regurgitation results when the Left ventricle contracts and blood flows back into the Left atrium. This can be heard in the 5th intercostal space, left midclavicular line.
A client with acute chest pain is given IV morphine. Which of the following is an expected effect of morphine?
SELECT ALL THAT APPLY
1/ Reduced myocardial oxygen consumption 2/ Promotes reduction in respiratory rate 3/ Prevents ventricular remodelling 4/ Reduces BP and HR 5/ Reduces Anxiety and Fear
1/ Reduced myocardial oxygen consumption
4/ Reduces BP and HR
5/ Reduces Anxiety and Fear
Morphine acts as an analgesic and sedative, and reduces myocardial oxygen consumption, blood pressure, and heart rate. It also reduces anxiety and fear due to its sedative effects and by slowing heart rate.
It can depress respirations, however such an effect may lead to hypoxia and would not be an EXPECTED effect during this course of treatment.
ACE-inhibitors prevent cardiac remodelling, not morphine.
The nurse as completed the assessment on a client with decreased cardiac output. Which finding should receive the highest priority?
A/ BP 110/62, A-fib with HR 82, Bilateral basilar crackles
B/ Confusion, urine output 15mL over last 2 hours, orthopnea
C/ Sp02 92% on 2L nasal cannula, respirations 20/min, 1+ edema in lower extremities
D/ Weight gain of 1kg in 3 days, BP 130/80, mild dyspnea with exercise
B/ Confusion, urine output 15mL over last 2 hours, orthopnea
A low urine output and confusion are signs of decreased tissue perfusion. Orthopnea is a sign of L-sided HF. Crackles, edema, and weight gain should be monitored closely, but are not at the highest priority. With A-fib, there is a loss of atrial kick, but the BP and their HR are normal.
The nurse observes the clients Heart rate drop from 62 bpm to 50 bpm on the monitor. The nurse should first: A/ Give atropine 0.5mg IV push B/ Auscultate for abnormal heart sounds C/ Prepare for transcutaneous pacing D/ Take the client's BP
D/ Take the client’s BP
Assess their tolerance to the recent bradycardia by checking their BP and level of consciousness to determine if atropine is needed.
If they are symptomatic, Atropine and transcutaneous pacing are interventions for bradycardia.
Transcutaneous pacing is the placement of Resuscitation pads on the client that directly traces cardiac rate and rhythm
A 60-year-old comes to the Emergency room complaining os severe mid-sternal chest pain that radiates to her left shoulder and arm. The initial diagnosis is an acute MI. Admission prescriptions include O2 by nasal cannula at 4L/min, CBC tests, chest radiograph, and morphine given IV. The nurse should first: A/ Give Morphine IV B/ Obtain 12- lead ECG C/ Obtain blood work D/ Prescribe chest radiograph
A/ Morphine
Although an ECG, Chest XRAY, and blood work are important, managing their severe pain is of upmost importance. Especially since pain elevates pulse, blood pressure, and respiratory effort.
A client admitted for an acute MI has developed cardiogenic shock. An arterial line is inserted. Which prescription should the nurse verify with the HCP prior to giving?
A/ Call for urine out less than 30mL/h for 2 hours
B/ Give Metoprolol 5mg IV push
C/ Prepare for a pulmonary artery catheter insertion
D/ Titrate dobutamine to keep systolic BP above 100mmHg.
B/ Give Metoprolol 5mg IV push
Metoprolol is indicated in the treatment of hemodynamically stable clients with acute MI to reduce cardiovascular mortality. Cardiogenic shock causes severe hemodynamic instability and a beta-blocker like Metoprolol will further depress myocardial contractility. The decrease in cardiac output will impair kidney perfusion.
Dobutamine will improve cardiac contracility and increase cardiac output that is depressed due to cardiogenic shock
The HCP prescribes continuous nitroglycerin IV infusion for a client with Myocardial infarction. The nurse should:
A/ Obtain an infusion pump for the medication
B/ Take blood pressure q4h
C/ Monitor urine output hourly
D/ Obtain serum K+ levels daily
A/ Obtain an infusion pump for the medication
Nitroglycerin always needs an electronic fusion pump to ensure accuracy. Blood pressure should be done with a continuous system and much more frequently than q4h.
C/ and D/ are not associated with Nitroglycerin IV
While caring for a client who has sustained an MI, the nurse notes 8 PVCs in a 1 minute time period on the ECG. The client is receiving an IV infusion of D5W 125mL/h and O2 at 2L/min. The nurse should first: A/ Increase IV fluids to 150mL/hr B/ Notify the HCP C/ Increase oxygen to 4L/min D/ Administer prescribed analgesic
B/ Notify the HCP
PVCs are often the precursor of life-threatening arrhythmias and V-fib. Occasional PVCs are not considered dangerous until you reach around 6/min, especially in a post MI client.
The HCP should be notified, and this will usually call for decreasing ventricular irritability which is done through the administration of Lidocaine hydrochloride
The nurse is caring for a client who recently had an MI and is currently on Clopidogrel. The nurse should develop a teaching plan that includes which points?
SELECT ALL THAT APPLY
A/ Report unexpected bleeding or bleeding that lasts a long time
B/ Take Clopidogrel with food
C/ Client may bruise more easily and may experience bleeding gums
D/ Clopidogrel works by preventing platelets from sticking together and forming clots
E/ Drink a glass of water after taking Clopidogrel
A/ Report unexpected bleeding or bleeding that lasts a long time
C/ Client may bruise more easily and may experience bleeding gums
D/ Clopidogrel works by preventing platelets from sticking together and forming clots
It is generally well absorbed when taken with food and can be taken without. Should be taken at the same time each day.
Bleeding is the most common side effect, and they must understand the importance of reporting any unwanted bleeding or profuse bleeding.
Who is at the greatest risk for Coronary artery disease?
A/ 32-year-old female with Mitral valve prolapse who quit smoking 10 years ago
B/ 43-year-old male with a family history of CAD and a cholesterol level of 8.8mmol/L
C/ 56-year-old male with an HDL of 3.3mmol/L who takes atorvastatin
D/ 65-year-old female who is obese with an LDL of 10.4mmol/L
D/ 65-year-old female who is obese with an LDL of 10.4mmol/L
The combination of postmenopausal, obesity, high LDL places this client at greatest risk.
Men over 45, women over 55, smoking, and obesity increases the risk for CAD.
Atorvastatin reduces LDL and decreased the risk of CAD
When monitoring a client who is given t-PA theray, the nurse should have resuscitation equipment nearby because of the re-perfusion of cardiac tissue can result in: A/ Cardiac arrhythmias B/ Hypertension C/ Seizures D/ Hypothermia
A/ Cardiac arrhythmias
These arrhythmias are associated with re-perfusion of cardiac tissue. Hypotension is commonly associated with t-PA, not hypertension. Options C/ and D/ are not associated.
Prior to giving t-PA therapy to a client, the nurse should monitor for which contraindication to therapy? A/ Age over 60 years B/ History of cerebral hemorrhage C/ History of HF D/ Cigarette smoking
B/ History of cerebral hemorrhage
t-PA therapy increases the risk of hemorrhaging.
A 56-year-old male is being admitted to the hospital with a history of hypertension and informs the nurse that his father died from a heart attack at 60 years old. The client reports having indigestion. The nurse connects the client to an ECG monitor which then reveals 8 PVCs in the course of 1 minute. The nurse should next: A/ Contact the HCP immediately B/ Start 2 IV lines C/ Obtain a portable chest XRAY D/ Draw blood for lab results
B/ Start 2 IV lines
Advanced cardiac life support recommends at least 1 or 2 IV lines are started in antecubital spaces (Elbow pit).
All other options are important and should be done quickly, however, IV is most important in this condition.
Why? From my experiences in the ER, I was told it is “easier to start any IV on someone alive then dead.”
A 68-year-old on day 2 after hip-surgery states he is having chest heaviness. He has no history of cardiac issues. The nurse should first:
A/ Inquire about the onset, duration, severity, and precipitating factors of the heaviness
B/ Give oxygen via nasal cannula
C/ Offer pain medications for chest heaviness
D/ Inform the HCP of the symptom
A/ Inquire about the onset, duration, severity, and precipitating factors of the heaviness
It is too early to initiate other actions until more information is gathered. Inquiring about onset, duration, severity, and precipitating factors of the heaviness will provide you more information to convey to the HCP if needed.
Which symptom should the nurse teach the client with unstable angina to report immediately the the HCP?
A/ A change in the pattern of chest pain
B/ Pain during sexual activity
C/ Pain during an argument
D/ Pain during or after physical activity
A/ A change in the pattern of chest pain
A change in pain patterns may indicate increasing severity of coronary occlusion and disease.
Pain may be expected with all other activities, and Nitro should be taken prior to each one if possible.
A client complains to the nurse that every time they take their Nitroglycerin, they get a severe headache. The nurse should instruct the client that:
A/ Tylenol or Advil can be taken for this common side effect
B/ Nitroglycerin should be avoided if the headache interrupts activities of daily living
C/ Taking your nitroglycerin with a few glasses of water will alleviate this issue.
D/ The client should lie in a supine position to avoid this side effect
A/ Tylenol or Advil can be taken for this common side effect
This is a common side effect. Give Tylenol or Advil
A client with Chronic Heart failure also has A-fib and left ventricular ejection fraction of 15%. The client is taking warfarin. The expected outcome of the drug is to: A/ Decrease circulatory overload B/ Improve myocardial workload C/ Prevent thrombus formation D/ Regulate cardiac rhythm
C/ Prevent thrombus formation
Warfarin is an anticoagulant used in the treatment of A-fib and left ventricular ejection fractions below 20%. They prevent thrombus formation.
A client with a history of Heart failure has been prescribed Lasix, Digoxin, and KCl. The client has nausea, blurred vision, headache and weakness. The nurse notes the client is also confused. Based on these findings, the nurse should expect this outcome as a result of: A/ Hyperkalemia B/ Digoxin Toxicity C/ Fluid deficit D/ Pulmonary edema
B/ Digoxin Toxicity
Early signs of toxicity with Digoxin include:
Anorexia
Nausea and Vomiting
Visual disturbances can also occur (blurred or double)
Hypokalemia is associated with Digoxin toxicity.
Pulmonary edema is manifested by dyspnea and coughing
