Cardiovascular Flashcards
The nurse receives handoff of care report on 4 clients. Which client should the nurse see first?
A. Client with AFib who reports feeling palpitations and has an irregular pulse of 122 bpm
B. Client with liver cirrhosis who reports bleeding from an IV insertion site and has a platelet count of 48 x 10^8/L
C. Client with pericarditis whose blood pressure has decreased from 122/70 mmHg to 98/68 mmHg over the past hour
D. Client with pneumonia whose WBC count has increased from 14 x 10^8/L 8 hours ago to 30 x 10^9/L
C.
Cardiac tamponade is a possible complication of acute pericarditis that impairs cardiac output and is life-threatening without immediate intervention.
Clinical features of cardiac tamponade include hypotension, muffled heart sounds, and neck vein distension (Beck triad).
The nurse is teaching a client diagnosed with Raynaud phenomenon about ways to prevent recurrent episodes. Which instructions should the nurse include? Select all that apply.
- Avoid excessive caffeine
- Immerse hands in cold water
- Practice yoga or tai chi
- Refrain from using tobacco products
- Wear gloves when handling cold objects
1, 3, 4, and 5
Raynaud phenomenon is a vasospastic disorder triggered by exposure to cold or stress.
It most commonly affects women age 15-40.
Key elements of client teaching include management of acute attack, avoidance of vasoconstrictive substances (e.g., tobacco, cocaine, caffeine), stress reduction, and appropriate clothing (e.g., gloves, warm layers).
The nurse cares for a client who had an abdominal aortic aneurysm repair 6 hours ago. Which assessment would require immediate follow-up?
A. Abdomen is soft, nondistended, and tender to touch.
B. Blood pressure is 96/88 mmHg and apical pulse is 112 bpm
C. Client rates pain as 4 on a scale of 0-10
D. Green bile is draining from the NG tube
B.
Abdominal aortic aneurysms can be surgically repaired via an EVAR or open repair surgery.
Following repair of an abdominal aortic aneurysm, hemodynamic stability is a priority.
Prolonged hypotension can lead to graft thrombosis. A falling blood pressure and rising pulse rate can also signify graft leakage.
The charge nurse is assisting with a nonemergent cardioversion for a client with supraventricular tachycardia. Which action by the primary nurse would cause the charge nurse to intervene?
A. Administers a one-time dose of IV midazolam
B. Disengages the “sync” function on the defibrillator
C. Places defibrillator pads on upper right and lower left chest
D. Turns off the client’s oxygen and moves it away from the bed
B.
Synchronized cardioversion is a cardiac procedure used to convert tachyarrhythmias with a pulse to stable cardiac rhythms.
Nurses preparing to perform cardioversion must verify that the defibrillator’s “sync” feature is engaged to prevent delivery of an asynchronous shock, which may cause life-threatening arrhythmias.
The shock must be delivered during the R wave of the QRS complex when the ventricles depolarize.
When admitting a client who had an anterior wall ST-elevation MI to the cardiac stepdown unit, which intervention should the nurse perform first?
A. Assess for jugular venous distension
B. Attach the cardiac monitor to the client
C. Auscultate heart and breath sounds
D. Obtain the client’s vital signs
B.
Dysrhythmias are the most frequent complication following MI, especially ventricular fibrillation.
The nurse should attach the cardiac monitor to the client before performing any other interventions in case antidysrhythmic drugs need to be given.
The nurse is performing a cardiac assessment on a client. The nurse auscultates a loud blowing sound at the second ICS, right sternal border. How should the nurse document this finding?
A. Arterial bruit
B. Murmur heard at the aortic area
C. Pericardial friction rub
D. S3 gallop heard at the mitral area
B.
Murmurs indicate turbulent blood flow across diseased or malformed cardiac valves.
They are often described as musical, blowing, or swooshing sounds that occur between normal heart sounds.
Aortic: 2nd ICS to the right sternal border
Pulmonic: 2nd ICS to the left sternal border
Erb’s point: 3rd ICS to the left sternal border
Tricuspid: 5th ICS to the lower left sternal border
Mitral: apex, PMI, 5th ICS at MCL
The nurse is teaching a client who is scheduled to have an inferior vena cava filter inserted via the right femoral vein. Which statement by the client requires further teaching?
A. “I need to make all health care providers aware of my filter before I have body scans.”
B. “I need to stay active and avoid crossing my legs for extended periods when I get home.”
C. “I should call the health care provider if I develop numbness, tingling, and swelling in my right leg.”
D. “It is normal to have some chest or back discomfort for a few days after filter placement.”
D.
An inferior vena cava filter traps thrombi migrating from the lower extremities to the lungs.
Discharge teaching includes promotion of physical exercise, reporting symptoms of pulmonary embolism and impaired lower extremity circulation, and notification of the health care team prior to MRI.
The nurse just administered a dose of 0.5 atropine to a client with a heart rate of 48 bpm and blood pressure of 90/62 mmHg. What do you expect to happen?
Atropine is given to clients with symptomatic bradycardia.
The desired outcomes would be an increase in heart rate, evidence of normal sinus rhythm on the cardiac monitor, and reversal of any clinical symptoms associated with the bradycardia.
A client comes to the emergency department in acute decompensated heart failure (ADHF). The client is very anxious with a respiratory rate of 30/min and pink, frothy sputum. After placing the client on oxygen via nasal cannula, which of these actions is the next priority?
A. Administer digoxin 0.25 mg
B. Administer furosemide 40 mg IV push
C. Initiate dopamine infusion at 5 mcg/kg/min
D. Obtain blood sample for arterial blood gases
B.
In the presence of ADHF and pulmonary edema, diuretic (e.g. furosemide) administration is effective in removing excess fluid to reduce pulmonary congestion and improve oxygenation.
Vasodilators (e.g. nitroglycerin) and positive inotropes (e.g. dopamine) are also used in the treatment of ADHF.
The nurse is caring for a client recently diagnosed with an active DVT. Which action by the client would require an immediate intervention by the nurse?
A. The client has a temperature of 37.7 C
B. The client is ambulating up and down the hallways
C. The client is breathing at a rate of 16/min
D. The client is massaging the leg at the site of inflammation
D.
Clients with active DVT are at risk for developing a PE.
DVT is best prevented by avoiding extended bed rest and encouraging ambulation even after diagnosis.
Massaging the site of inflammation is highly discouraged!
A client with severe vomiting and diarrhea has a blood pressure of 90/70 mmHg and pulse of 120 bpm. IV fluids of 2 L normal saline were administered. Which parameters indicate that adequate rehydration has occurred? Select all that apply.
- Capillary refill less than 3 seconds
- Pulse pressure is lowered
- Systolic blood pressure drops only when standing
- Urine output is 360 mL in 4 hours
- Urine specific gravity is 1.020
1, 4, and 5
Signs of adequate hydration are capillary refill less than 3 seconds, adequate volume of urine output (> 30 mL/hr), and normal urine specific gravity (1.003 to 1.030).
Pulse pressure narrows in shock and positive orthostatic vital signs with position change indicate dehydration.
A client with PAD is visiting the health clinic. The nurse completes a health assessment. Which statement by the client indicates a priority need for follow-up teaching?
A. “I always take my simvastatin in the evening.”
B. “I prop my legs up in the recliner and use a heating pad when my feet are cold.”
C. “I’ve been walking on my treadmill at home for 15 min each day.”
D. “I’ve noticed that I don’t have much hair on my lower legs anymore.”
B.
Clients with PAD have decreased sensations from nerve ischemia or coexisting DM.
They should never apply direct heat to the extremity due to the risk for a burn wound. Wound healing is impaired in these clients.
Clients with PAD usually do not have swelling, but rather have decreased blood supply. The extremities should not be elevated above the level of the heart b/c extreme elevation further impedes arterial blood flow to the feet.
A client is being discharged after receiving an implantable cardioverter defibrillator. Which statement by the client indicates that teaching has been effective?
A. “I’m not worried about the device firing now b/c I know it won’t hurt.”
B. “I will let my daughter fix my hair until my health care provider says I can do it.”
C. “I will look into public transportation b/c I won’t be able to drive again.”
D. “I will notify my travel agent that I can no longer travel by plane.”
B.
An implantable cardioverter defibrillator can sense and defibrillate life-threatening dysrhythmias.
It also includes pacemaker capabilities such as overdrive pacing for rapid heart rhythms or back-up pacing for bradycardias.
After placement of an implantable cardioverter defibrillator, clients are instructed to avoid lifting the associated arm above the shoulder until cleared by the health care provider.
The nurse received handoff report on assigned clients. Which client should the nurse assess first?
A. Client 1 day post femoral-popliteal bypass surgery who now has a nonpalpable pedal pulse present only with Doppler
B. Client with chronic venous insufficiency who has edema and brown discolouration of the lower extremities
C. Client with PAD and gangrene of the foot who has a cool-to-the-touch, hairless extremity
D. Client with PAD who reports severe cramping pain in the calf with activity such as walking
A.
Femoral-popliteal bypass surgery involves circumventing a blockage in the femoral artery with a synthetic or autogenous (artery or vein) graft to restore blood flow.
Absent or decreased volume in the peripheral pulses distal to the graft can indicate compromised circulation or graft occlusion and should be reported to the health care provider immediately.
The nurse is preparing to administer medications after assessing a client with a MI. Based on the collected data, which of the following prescribed medications are appropriate for the nurse to administer? T = 36.9 C, BP = 126/81 mmHg, HR = 49 bpm, RR = 16/min. LDL cholesterol = 5.18 mmol/L. Select all that apply.
- Aspirin
- Atorvastatin
- Docusate sodium
- Lisinopril
- Metoprolol
1, 2, 3, and 4
Aspirin is an antiplatelet agent that inhibits platelet aggregation, prevents thrombus formation, and reduces heart inflammation.
Atorvastatin is a lipid-lowering medication given to clients to lower cholesterol levels, which reduces plaque and reinfarction risk.
Docusate sodium is a stool softener that reduces straining during bowel movements, thereby decreasing the workload of the heart.
Lisinopril is an ACE inhibitor often prescribed to client after an MI to prevent ventricular remodeling and progression of heart failure. It may cause hyperkalemia and hypotension.
Metoprolol is a beta blocker prescribed to clients after MI to reduce risk of reinfarction and heart failure, but it lowers blood pressure and heart rate.
