Chapter 13: Cardiovascular Diagnostic Procedures Flashcards
A patient with a serum potassium level of 6.8 mEq/L may exhibit what type of electrocardiographic changes?
a. A prominent U wave
b. Tall, peaked T waves
c. A narrowed QRS
d. Sudden ventricular dysrhythmias
ANS: B
Normal serum potassium levels are 3.5 to 4.5 mEq/L. Tall, narrow peaked T waves are usually, although not uniquely, associated with early hyperkalemia and are followed by
prolongation of the PR interval, loss of the P wave, widening of the QRS complex, heart block, and asystole. Severely elevated serum potassium (greater than 8 mEq/L) causes a
wide QRS tachycardia.
What places a patient with heart failure at risk for hypomagnesemia?
a. Pump failure
b. Diuretic use
c. Fluid overload
d. Inotropic drugs
ANS: B
Hypomagnesemia can be caused by diuresis. Diuretic use with heart failure often contributes to low serum magnesium levels.
Which diagnostic test is most effective for measuring overall heart size?
a. 12-lead electrocardiography
b. Echocardiography
c. Chest radiography
d. Vectorcardiography
ANS: C
Chest radiography is the oldest noninvasive method for visualizing images of the heart, and it remains a frequently used and valuable diagnostic tool. Information about cardiac anatomy and physiology can be obtained with ease and safety at a relatively low cost. Radiographs of the chest are used to estimate the cardiothoracic ratio and measure overall heart size.
What is the most accurate method for monitoring the existence of true ischemic changes?
a. Biomarkers
b. Echocardiogram
c. 5-lead ECG
d. 12-lead ECG
ANS: D
Cardiac biomarkers are proteins that are released from damaged myocardial cells. The initial
elevation of cTnI, cTnT, and CK-MB occurs 3 to 6 hours after the acute myocardial damage. This means that if an individual comes to the emergency department as soon as
chest pain is experienced, the biomarkers will not have risen. For this reason, it is clinical practice to diagnose an acute myocardial infarction by 12-lead electrocardiography and clinical symptoms without waiting for elevation of cardiac biomarkers
Which criteria are representative of the patient in normal sinus rhythm?
a. Heart rate, 64 beats/min; rhythm regular; PR interval, 0.10 second; QRS, 0.04 second
b. Heart rate, 88 beats/min; rhythm regular; PR interval, 0.18 second; QRS, 0.06 second
c. Heart rate, 54 beats/min; rhythm regular; PR interval, 0.16 second; QRS, 0.08 second
d. Heart rate, 92 beats/min; rhythm irregular; PR interval, 0.16 second; QRS, 0.04 second
ANS: B
The parameters for normal sinus rhythm are heart rate, 60 to 100 beats/min; rhythm, regular; PR interval, 0.12 to 0.20 second; and QRS, 0.06 to 0.10 second.
What cardiac influence ability to response to causes the patient to have symptoms with atrial flutter?
a. Atrial response rate
b. Ventricular response rate
c. PR interval
d. QRS duration
ANS: B
The major factor underlying atrial flutter symptoms is the ventricular response rate. If the atrial rate is 300 and the atrioventricular (AV) conduction ratio is 4:1, the ventricular
response rate is 75 beats/min and should be well tolerated. If, on the other hand, the atrial rate is 300 beats/min but the AV conduction ratio is 2:1, the corresponding ventricular rate of 150 beats/min may cause angina, acute heart failure, or other signs of cardiac decompensation.
What characteristic is associated with junctional escape rhythms?
a. Irregular rhythm
b. Rate greater than 100 beats/min
c. P wave may inverted or absent
d. QRS greater than 0.10 seconds
ANS: C
Characteristics of a junctional escape rhythm include a rate of 40 to 60 beats/min, regular rhythm, present or absent P waves, PR less than 0.12 seconds, and QRS between 0.06 and
0.10 seconds.
When assessing a patient with PVCs, the nurse knows that the ectopic beat is multifocal by what characteristic?
a. In various shapes in the same lead
b. With increasing frequency
c. Wider than a normal QRS
d. On the T wave
ANS: A
If the ventricular ectopic beats are of various shapes in the same lead, they are multifocal. Multifocal ventricular ectopic beats are more serious than unifocal ventricular ectopic beats
because they indicate a greater area of irritable myocardial tissue and are more likely to deteriorate into ventricular tachycardia or fibrillation.
What major clinical finding is present with ventricular fibrillation (VF)?
a. Hypertension
b. Bradycardia
c. Diaphoresis
d. Pulselessness
ANS: D
In ventricular fibrillation (VF), the patient does not have a pulse, no blood is being pumped forward, and defibrillation is the only definitive therapy. No forward flow of blood or
palpable pulse is present in VF.
Which portion of the electrocardiogram (ECG) is most valuable in diagnosing atrioventricular (AV) conduction disturbances?
a. P wave
b. PR interval
c. QRS complex
d. QT interval
ANS: B
The PR interval is an indicator of atrioventricular nodal function. The P wave represents atrial depolarization. The QRS complex represents ventricular depolarization, corresponding to phase 0 of the ventricular action potential. The QT interval is measured from the beginning of the QRS complex to the end of the T wave and indicates the total time interval from the onset of depolarization to the completion of repolarization
Which findings would be reasons to abort an exercise stress test?
a. Ventricular axis of +90 degrees
b. Increase in blood pressure
c. Inverted U wave
d. ST segment depression or elevation
ANS: D
Signs that can alert the nurse to stop the test include ST segment elevation equal to or greater than 1.0 mm (one small box) or ST depression equal to or greater than 2.0 mm (2 small boxes). Blood pressure is expected to rise during exercise, but a systolic blood pressure greater than 250 mm Hg or a diastolic blood pressure greater than 115 mm Hg is considered high enough to stop the test. Parameters for ventricular axis in degrees are –30 to +90. Left-axis deviation is present if the axis falls between –30 and –90 degrees.
What is the rationale for giving the patient additional fluids after a cardiac catheterization?
a. Fluids help keep the femoral vein from clotting at the puncture site.
b. The patient had a nothing-by-mouth order before the procedure.
c. The radiopaque contrast acts as an osmotic diuretic.
d. Fluids increase cardiac output and prevent rehydration.
ANS: C
Fluid is given for rehydration because the radiopaque contrast acts as an osmotic diuretic. Fluid is also used to prevent contrast-induced nephropathy or damage to the kidney from the contrast dye used to visualize the heart structures.
How can pulsus paradoxus finding be assessed on the bedside monitor?
a. A decrease of more than 10 mm Hg in the arterial waveform during inhalation
b. A single, nonperfused beat on the electrocardiogram (ECG) waveform
c. Tall, tented T waves on the ECG waveform
d. An increase in pulse pressure greater than 20 mm Hg on exhalation
ANS: A
Pulsus paradoxus is a decrease of more than 10 mm Hg in the arterial waveform that occurs during inhalation. It is caused by a fall in cardiac output (CO) as a result of increased negative intrathoracic pressure during inhalation.
When assessing the pulmonary arterial waveform, the nurse notices dampening. After tightening the stopcocks and flushing the line, the nurse decides to calibrate the transducer. What are two essential components included in calibration?
a. Obtaining a baseline blood pressure and closing the transducer to air
b. Leveling the transducer to the phlebostatic axis and opening the it to air
c. Having the patient lay flat and closing the transducer to air
d. Obtaining blood return on-line and closing all stopcocks
ANS: B
Ensuring accuracy of waveform calibration of the system includes opening the transducer to air and leveling the air–fluid interface of the transducer to the phlebostatic axis
What is the formula for calculating mean arterial pressure (MAP)?
a. Averaging three of the patient’s blood pressure readings over a 6-hour period
b. Dividing the systolic pressure by the diastolic pressure
c. Adding the systolic pressure and two diastolic pressures and then dividing by 3
d. Dividing the diastolic pressure by the pulse pressure
ANS: C
The mean arterial pressure is one-third systole and two-thirds diastole.
What is the physiologic effect of left ventricular afterload reduction?
a. Decreased left atrial tension
b. Decreased systemic vascular resistance
c. Increased filling pressures
d. Decreased cardiac output
ANS: B
Afterload is defined as the pressure the ventricle generates to overcome the resistance to ejection created by the arteries and arterioles. After a decrease in afterload, wall tension is
lowered. The technical name for afterload is systemic vascular resistance (SVR). Resistance to ejection from the right side of the heart is estimated by calculating the pulmonary vascular resistance (PVR). The PVR value is normally one-sixth of the SVR
What parameter is used to assess the contractility of the left side of the heart?
a. Pulmonary artery occlusion pressure
b. Left atrial pressure
c. Systemic vascular resistance
d. Left ventricular stroke work index
ANS: D
Contractility of the left side of the heart is measured by the left ventricular stroke work index.
Which intervention should be strictly followed to ensure accurate cardiac output readings?
a. Inject 5 mL of iced injectate at the beginning of exhalation over 30 seconds.
b. Inject 10 mL of warmed injectate into the pulmonary artery port three times.
c. Ensure at least 5 C difference between injectate and the patient temperature.
d. Administer the injectate within 4 seconds during inspiration.
ANS: D
To ensure accurate readings, the difference between injectate temperature and body temperature must be at least 10 C, and the injectate must be delivered within 4 seconds, with minimal handling of the syringe to prevent warming of the solution. This is particularly
important when iced injectate is used.
Why is mixed venous oxygen saturation (SVO2 ) monitoring helpful in the management of
the critically ill patient?
a. It facilitates oxygen saturation monitoring at the capillary level.
b. It can detect an imbalance between oxygen supply and metabolic tissue demand.
c. It assesses the diffusion of gases at the alveolar capillary membrane.
d. It estimates myocardial workload during heart failure and acute pulmonary edema.
ANS: B
Continuous venous oxygen monitoring permits a calculation of the balance achieved between arterial oxygen supply (SaO2 ) and oxygen demand at the tissue level by sampling desaturated venous blood from the PA catheter distal tip.
A patient reports that he has been having “indigestion” for the last few hours. Upon further review the nurse suspects the patient is having of chest pain. Cardiac biomarkers and a 12-lead electrocardiogram (ECG) are done. What finding is most significant in diagnosing an acute coronary syndrome (ACS) within the first 3 hours?
a. Inverted T waves
b. Elevated troponin I
c. Elevated B-type natriuretic peptide (BNP)
d. Indigestion and chest pain
ANS: B
The troponins are biomarkers for myocardial damage. The elevation of Troponin I and troponin T occurs 3 to 6 hours after acute myocardial damage. Because troponin I is found
only in cardiac muscle, it is a highly specific biomarker for myocardial damage. B-type natriuretic peptide (BNP) is usually drawn when heart failure is suspected, not acute
coronary syndrome (ACS). Usually within 4 to 24 hours from the onset of the infarction, abnormal Q waves begin to develop in the affected leads, and T waves begin to invert.
Which serum lipid value is a significant predictor of future acute myocardial infarction (MI) in persons with established coronary artery atherosclerosis?
a. High-density lipoprotein (HDL)
b. Low-density lipoprotein (LDL)
c. Triglycerides
d. Very-low-density lipoprotein
ANS: B
Both the LDL-C and total serum cholesterol levels are directly correlated with risk for coronary artery disease, and high levels of each are significant predictors of future acute myocardial infarction in persons with established coronary artery atherosclerosis. LDL-C is
the major atherogenic lipoprotein and thus is the primary target for cholesterol-lowering efforts.
Which of the electrocardiogram (ECG) findings would be positive for an inferior wall myocardial infarction (MI)?
a. ST segment depression in leads I, aVL, and V2 to V4
b. Q waves in leads V1 to V2
c. Q waves in leads II, III, and aVF
d. T-wave inversion in leads V4 to V6, I, and aVL
ANS: C
Abnormal Q waves develop in leads overlying the affected area. An inferior wall infarction is seen with changes in leads II, III, and aVF. Leads I and aVF are selected to detect a sudden change in ventricular axis. If ST segment monitoring is required, the lead is selected according to the area of ischemia. If the ischemic area is not known, leads V3 and III are
recommended to detect ST segment ischemia.
A patient’s bedside electrocardiogram (ECG) strips show the following changes: increased
PR interval; increased QRS width; and tall, peaked T waves. Vital signs are temperature 98.2 F; heart rate 118 beats/min; blood pressure 146/90 mm Hg; and respiratory rate 18 breaths/min. The patient is receiving the following medications: digoxin 0.125 mg PO every day; D5 1/2 normal saline with 40 mEq potassium chloride at 125 mL/h; Cardizem at 30 mg PO q8h; and aldosterone at 300 mg PO q12h. The practitioner is notified of the ECG
changes. What orders should the nurse expect to receive?
a. Change IV fluid to D51/2 normal saline and draw blood chemistry.
b. Give normal saline with 40 mEq of potassium chloride over a 6-hour period.
c. Hold digoxin and draw serum digoxin level.
d. Hold Cardizem and give 500 mL normal saline fluid challenge over a 2-hour period.
ANS: A
The electrocardiographic (ECG) changes are most consistent with hyperkalemia. Removing the potassium from the intravenous line and drawing laboratory values to check the potassium level is the best choice with the least chance of further harm. Digoxin toxicity can
be suspected related to the prolonged PR interval, but hyperkalemia explains all the ECG
changes. The patient is not hypotensive or bradycardic, so holding the Cardizem is not
indicated.
A patient with a potassium level of 2.8 mEq/L is given 60 mEq over a 12-hour period. A repeat potassium level is obtained, and the current potassium level is 3.2 mEq/L. In addition to administering additional potassium supplements, what intervention should now be
considered?
a. Discontinue spironolactone
b. Drawing a serum magnesium level
c. Rechecking the potassium level
d. Monitoring the patient’s urinary output
ANS: B
The patient should have serum magnesium level drawn. Hypomagnesemia is commonly
associated with other electrolyte imbalances, most notably alterations in potassium, calcium, and phosphorus. Low serum magnesium levels can result from many causes.