LA#5 ( Cardio (2)) Chapters 37, 38, 39, 40 in Med Surg Flashcards
In analyzing a patient’s electrocardiogram (ECG) rhythm strip, the nurse uses the knowledge that the time of the conduction of an impulse through the Purkinje fibres is represented by which of the following changes? a. P wave b. PR interval c. QT interval d. QRS complex `
ANS: B
The PR interval represents depolarization of the atria, atrioventricular (AV) node, bundle of His, bundle branches, and Purkinje fibres, up to the point of depolarization of the ventricular cells.
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Which of the following is an abnormal ECG value for a PR interval duration?
a. 0.6 second
b. 0.12 second
c. 0.24 second
d. 0.30 second
ANS: B
The normal duration of a PR interval is 0.12 to 0.20 seconds.
A patient has a sinus arrest with a junctional escape rhythm. What would the nurse expect the patient’s pulse rate to be?
a. 15 to 20 beats/min
b. 20 to 40 beats/min
c. 40 to 60 beats/min
d. 60 to 100 beats/min
ANS: C
If the sinoatrial node fails to discharge, the junction will automatically discharge at the normal junctional rate of 40 to 60 beats/min.
A patient has a dysrhythmia that requires careful monitoring of atrial activity. Which lead will be best to use for continuous monitoring?
a. MCL1
b. AVF
c. V6
d. I
ANS: A
Leads II and MCL1 are the best leads for visualization of P waves, which reflect atrial activity.
The nurse obtains a monitor strip on a patient admitted to the coronary care unit with a myocardial infarction (MI) and makes the following analysis: P wave not apparent; ventricular rate 142 beats/min, R-R interval regular; PR interval not measurable; and QRS complex wide and distorted, greater than 0.14 second. The nurse interprets this patient’s cardiac rhythm as which of the following?
a. Atrial fibrillation
b. Sinus tachycardia
c. Ventricular fibrillation
d. Ventricular tachycardia
ANS: D
The absence of P waves, wide QRS, rate greater than 150 beats/min, and regularity of the rhythm indicate ventricular tachycardia.
The nurse determines that a patient has ventricular bigeminy when the rhythm strip indicates which of the following changes?
a. Conduction is originating in the AV node.
b. Every other QRS complex is wide and starts prematurely.
c. The ventricular rate is between 150 and 250 beats/min.
d. The rhythm of the SA node is coupled with long pauses between every two beats.
ANS: B
Ventricular bigeminy describes a rhythm in which every other QRS complex is wide and bizarre looking.
A patient has a normal cardiac rhythm strip, except that the PR interval is 0.34 seconds. What is the appropriate nursing intervention?
a. Notify the physician.
b. Administer atropine per protocol.
c. Prepare the patient for temporary pacemaker insertion.
d. Document the finding, and continue to monitor the patient.
ANS: D
First-degree AV block is asymptomatic and requires ongoing monitoring because it may progress to more serious forms of heart block.
A patient with diabetes mellitus is admitted unresponsive to the emergency department (ED). Initial laboratory findings are serum potassium 2.8 mmol/L, serum sodium 138 mmol/L, serum chloride 90 mmol/L, and blood glucose 34.9 mmol/L (628 mg/dL). Cardiac monitoring shows multifocal premature ventricular contractions (PVCs). What does the nurse understand that the patient’s PVCs are most likely caused by?
a. Hypoxemia
b. Dehydration
c. Hypokalemia
d. Hyperglycemia
ANS: C
Hypokalemia increases the risk for ventricular dysrhythmias such as PVCs, ventricular tachycardia, and ventricular fibrillation.
The nurse retrieves data from the cardiac monitor that indicates that a patient with an MI experienced a 45-second episode of ventricular tachycardia before a normal sinus rhythm and a heart rate of 98 were re-established. What is the most appropriate initial nursing action?
a. Notify the physician.
b. Administer antidysrhythmic drugs per protocol.
c. Elevate the head of the bed, and administer oxygen at 6 L/min.
d. Continue to monitor the patient’s cardiac rhythm without other interventions at this time.
ANS: B
The burst of sustained ventricular tachycardia indicates that the patient has significant ventricular irritability, and antidysrhythmic medication administration is needed to prevent further episodes.
A patient with myocardial damage develops a type I, second-degree AV block. The nurse administers IV atropine as prescribed. The nurse determines that the medication has been effective on finding which of the following changes?
a. A decrease in ventricular response
b. A decrease in premature contractions
c. An increase in the patient’s heart rate
d. Increased carotid and peripheral pulse volume
ANS: C
Atropine will increase the heart rate and conduction through the AV node
What is the most accurate way to calculate the heart rate from an ECG?
a. Count the number of R-R intervals in 6 seconds, and multiply by 10.
b. Count the number of small squares between the R-R interval, and divide by 1500.
c. Count the number of QRS complexes in 1 minute.
d. Count the large squares between one R-R interval, and divide by 300.
ANS: C
The most accurate way to obtain a heart rate from an ECG is to count the number of QRS complexes in 1 minute.
The cardiac monitor alarm goes off for a patient being monitored in the coronary care unit, and the nurse notes a cardiac pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious, with no pulse or respirations. After calling for assistance, what should the nurse do?
a. Start basic cardiopulmonary resuscitation (CPR).
b. Administer a bolus dose of epinephrine.
c. Prepare the patient for endotracheal intubation.
d. Wait for the defibrillator to arrive at the bedside.
ANS: A
The patient’s rhythm and assessment indicate ventricular fibrillation and cardiac arrest; therefore, the initial actions include calling for help and initiating CPR until defibrillation is possible.
During the change-of-shift report, the nurse learns that a patient with a large MI has been having frequent PVCs. What will the nurse check when monitoring the patient for the effects of PVCs?
a. The patient’s medications
b. The patient’s oxygen saturation
c. The patient’s apical–radial heart rate
d. The patient’s recent electrolyte values
ANS: C
It is important to assess the patient’s apical–radial pulse rate because PVCs often do not generate a sufficient ventricular contraction to result in a peripheral pulse, which can lead to a pulse deficit.
How would the nurse document a dysrhythmia pattern that has a sawtooth-shape P wave, a variable PR interval, and a normal QRS complex?
a. Junctional rhythms
b. Atrial flutter
c. Sinus bradycardia
d. Atrial fibrillation
ANS: B
A dysrhythmia pattern that has a sawtooth-shape P wave, a variable PR interval, and a normal QRS complex is an atrial flutter.
Which classification of antidysrhythmia drugs has no effect on ECG?
a. Class I: sodium channel blockers
b. Class II: β-adrenergic blockers
c. Class III: potassium channel blockers
d. Class IV: calcium channel blockers
ANS: A
Class I: sodium channel blockers have no effect on ECG.
The nurse is doing discharge teaching with a patient who is going home with an implantable cardioverter–defibrillator (ICD). Which of the following instructions should the nurse give the patient?
a. Keep the incision dry for at least 2 weeks after ICD insertion.
b. The ICD will not set off a metal detector in an airport, so it is all right to travel.
c. You should have a routine ICD check every 2 to 3 months.
d. It is all right to drive as soon as you are discharged.
ANS: C
Routine ICD check with interrogator–programmer device is needed every 2 to 3 months.
A patient has a permanent pacemaker inserted for treatment of chronic atrial fibrillation with slow ventricular response. The nurse recognizes that the pacemaker is used for the patient to do which of the following?
a. Prevent ventricular irritability.
b. Override the ectopic stimulus in the atria.
c. Fire an impulse every second to maintain a heart rate of 60 beats/min.
d. Discharge an electrical stimulus when no ventricular depolarization is sensed.
ANS: D
The permanent pacemaker will discharge when the ventricular rate drops below the set rate.
A patient has received instruction on the management of her permanent pacemaker before discharge from the hospital. The nurse recognizes that teaching has been effective when the patient makes which of the following statements?
a. “I won’t lift the arm on the pacemaker side up very high until I see the doctor.”
b. “I will notify the airlines when I make a reservation that I have a pacemaker.”
c. “I must avoid cooking with a microwave oven or being near a microwave in use.”
d. “It will be 6 weeks before I can take a bath or return to my usual activities.”
ANS: A
The patient is instructed to avoid lifting the arm on the pacemaker side above the shoulder to avoid displacing the pacemaker leads.
A patient who has been successfully resuscitated twice following sudden cardiac death has a transvenous ICD implanted for management of ventricular dysrhythmias. When performing discharge teaching with the patient, what is most important for the nurse to instruct the patient and family about?
a. He will no longer need to take medications to control his dysrhythmias.
b. If the ICD fires and he loses consciousness, 911 should be called.
c. His family will not need to learn CPR because he has the automatic defibrillator available.
d. The ICD device rarely sets off airport security alarms, and travel without restrictions is allowed.
ANS: B
If the ICD fires and the patient continues to have symptoms of cardiac arrest, activation of the emergency response system is indicated.
A patient with supraventricular tachycardia is to receive cardioversion. What should the nurse know about the use of cardioversion?
a. A defibrillator is programmed to deliver a countershock on the T wave.
b. The amount of voltage used is 400 J.
c. The patient should be sedated before the procedure, if possible.
d. The procedure is the same as defibrillation, except that the patient is more hemodynamically stable.
ANS: C
When a patient has a nonemergency cardioversion, sedation is used just before the procedure.
A patient’s sinus rhythm rate is 62 beats/min. The PR interval is 0.18 seconds at 0100 hours, 0.20 seconds at 1230 hours, and 0.23 seconds at 1600 hours. Which action should the nurse take?
a. Document the patient’s rhythm, and continue to monitor.
b. Prepare for possible pacemaker insertion.
c. Hold the ordered metoprolol (Lopressor), and call the physician.
d. Give the as-needed dose of lidocaine (Xylocaine).
ANS: C
The patient has progressive first-degree AV block, and the β-blocker should be held until discussing the medication with the physician.
A patient develops sinus bradycardia at a rate of 32 beats/min, has a BP of 80/36 mm Hg, and is complaining of feeling faint. Which action should the nurse take?
a. Continue to monitor the rhythm and BP.
b. Obtain and apply the transcutaneous pacemaker.
c. Give the scheduled dose of diltiazem (Cardizem).
d. Have the patient perform the Valsalva manoeuvre.
ANS: B
The patient is experiencing symptomatic bradycardia, and treatment with the transcutaneous pacemaker is appropriate.
A 21-year-old college student arrives at the student health centre at the end of the quarter complaining, “My heart is skipping beats.” The nurse obtains an ECG and notes the presence of occasional PVCs. What action should the nurse take first?
a. Ask the patient about any history of coronary artery disease.
b. Question the patient about current stress level and coffee use.
c. Have the patient transported to the hospital ED.
d. Administer O2 to the patient at 2 to 3 L/min using nasal prongs.
ANS: B
In a patient with a normal heart, occasional PVCs are a benign finding. The timing of the PVCs suggests stress or caffeine as a possible etiological factor.
A 19-year-old student has a mandatory ECG before participating on a university swim team and is found to have sinus bradycardia, rate 52 beats/min. BP is 114/54 mm Hg, and the student denies any health problems. Which nursing action is appropriate?
a. Refer the student to a cardiologist for further assessment.
b. Allow the student to participate on the swim team.
c. Obtain more detailed information about the student’s health history.
d. Tell the student to stop swimming immediately if any dyspnea occurs.
ANS: B
In an aerobically trained individual, sinus bradycardia is normal. The student’s normal BP and negative health history indicate that a cardiology referral or more detailed information about the health history is not necessary. Dyspnea during an aerobic activity such as swimming is normal.
When analyzing the waveforms of a patient’s ECG, which finding will the nurse need to investigate further?
a. PR interval of 0.18 second
b. QRS interval of 0.14 second
c. T wave of 0.16 second
d. QT interval of 0.34 second
ANS: B
Because the normal QRS interval is 0.06 to 0.10 second, the patient’s QRS interval of 0.14 second indicates that the conduction through the ventricular conduction system is prolonged.
The nurse obtains a health history from a patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which is the most appropriate question for the nurse to ask?
a. “Do you have a history of a heart attack?”
b. “Have you had any recent immunizations?”
c. “Have you been to the dentist lately?”
d. “Do you have a family history of endocarditis?”
ANS: C
Dental procedures place the patient with a prosthetic mitral valve at risk for IE.
The physician writes the following admitting orders for a patient with suspected IE who has fever and chills: ceftriaxone (Rocephin) 1.0 g intravenous (IV) piggyback every 12 hours, aspirin for a temperature above 38.9°C, blood cultures × 3, complete blood count, and electrocardiogram (ECG). When admitting the patient, to which of the following orders should the nurse give the highest priority?
a. Scheduling the ECG
b. Initiating the intravenous (IV) antibiotic
c. Obtaining the blood cultures
d. Administering the antipyretic agent
ANS: C
Treatment of the IE with antibiotics should be started as quickly as possible, but it is essential to obtain blood cultures before initiating antibiotic therapy to obtain accurate sensitivity results.
During the assessment of a patient with IE, what would the nurse expect to find?
a. A new regurgitant murmur
b. Splinter hemorrhages of the lips
c. Dyspnea and a dry, hacking cough
d. Substernal chest pain and pressure
ANS: A
New regurgitant murmurs occur in IE because vegetation on the valves prevents valve closure.
A patient is admitted to hospital with a diagnosis of myocarditis. The nurse knows that early cardiac manifestations will appear approximately how long after viral infection?
a. 24 to 48 hours
b. 3 to 5 days
c. 7 to 10 days
d. 2 to 3 weeks
ANS: C
Early cardiac manifestations appear 7 to 10 days after viral infection.
A patient hospitalized with a streptococcal IE tells the nurse that the physician said treatment would require 4 to 6 weeks of antibiotic therapy and says she needs to get back to work as soon as possible. In advising the patient about the expected regimen for IE, what should the nurse explain about the treatment?
a. After 2 weeks of IV antibiotic therapy, she may be discharged with oral antibiotics to take for another 4 weeks.
b. Hospitalization for 4 to 6 weeks will be necessary to prevent a relapse while she receives IV antibiotic therapy.
c. She may be able to receive outpatient IV antibiotic therapy with home nursing care if complications do not develop.
d. She will be able to return to work as soon as her fever subsides if she does not develop any symptoms of heart failure.
ANS: C
Treatment for IE involves 4 to 6 weeks of IV antibiotic therapy to eradicate the bacteria, but patients frequently receive IV antibiotics on an outpatient basis.
A patient who is hospitalized with IE develops sharp left flank pain and hematuria. The nurse notifies the physician, recognizing that these symptoms may indicate which of the following complications?
a. Bacterial colonization in the kidneys
b. Vegetative embolization to the kidneys
c. Septicemia resulting in decreased glomerular blood flow
d. Hemolysis of red blood cells by hemolytic microorganisms
ANS: B
The patient’s clinical manifestations and history of IE indicate embolization. Sudden-onset flank pain is not typical of pyelonephritis, septicemia, or glomerulonephritis.
A patient is admitted to the hospital with possible acute pericarditis. The nurse explains to the patient that to confirm a diagnosis of acute pericarditis, the physician will most likely use which of the following tests?
a. Multiple ECGs
b. Daily blood cultures
c. Cardiac catheterization
d. Fluid obtained by pericardiocentesis
ANS: A
Pericarditis causes changes such as ST-segment elevation in multiple leads on the ECG, which evolve over the course of the inflammatory process, so multiple ECGs are warranted.
To assess the patient with pericarditis for the presence of a pericardial friction rub, the nurse should undertake which of the following actions?
a. Place the diaphragm of the stethoscope at the lower left sternal border of the chest.
b. Ask the patient to stop breathing during auscultation to distinguish the sound from a pleural rub.
c. Use the diaphragm of the stethoscope to listen for a rumbling, low-pitched sound that occurs during systole.
d. Palpate the precordial area with the tips of the fingers to detect a vibration that occurs with each cardiac contraction.
ANS: A
Pericardial friction rubs are heard best with the diaphragm at the lower left sternal border.
The nurse suspects the development of cardiac tamponade in a patient with acute pericarditis on finding which of the following data?
a. Blood pressure 166/96 mm Hg
b. Jugular vein distension (JVD) to the level of the jaw
c. A pulsus paradoxus of 8 mm Hg
d. Level 6 chest pain on a 10-point scale with deep inspiration
ANS: B
The JVD indicates that the patient may have developed cardiac tamponade and may need rapid intervention to maintain adequate cardiac output.
Cardiac tamponade is suspected in a patient who has acute pericarditis. To assess for the presence of pulsus paradoxus, what should the nurse do?
a. Subtract one third of the diastolic BP from the systolic BP.
b. Auscultate for a pericardial friction rub that increases in volume during inspiration.
c. Evaluate the rhythm of the pulse in relation to the patient’s inspiration and expiration.
d. Note the first Korotkoff sound occurring during both inspiration and expiration while deflating the blood pressure cuff.
ANS: D
Pulsus paradoxus exists with a gap of greater than 10 mm Hg between when Korotkoff sounds can be heard during only expiration and when they can be heard throughout the respiratory cycle.
The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a patient with acute pericarditis. What is the most appropriate nursing intervention for this problem?
a. Force fluids to 3000 mL/day to decrease fever and inflammation.
b. Teach the patient to take deep, slow respirations to control the pain.
c. Position the patient in a Fowler’s position, leaning forward on a padded overbed table.
d. Consult with the physician to provide patient-controlled analgesia with a narcotic analgesic.
ANS: C
Sitting upright and leaning forward frequently will decrease the pain associated with pericarditis.
While obtaining a nursing history from a 23-year-old man with rheumatic fever, what information related by the patient does the nurse recognize as the most significant?
a. Has used illicit IV drugs within the last 3 months
b. Has been unemployed for 6 months and has been eating poorly
c. Suffered chest trauma with a fractured rib during a fight 2 weeks ago
d. Has had a recent sore throat
ANS: D
Rheumatic fever occurs as a result of an abnormal immune response to a streptococcal infection.
A 22-year-old patient with rheumatic fever has subcutaneous nodules, erythema marginatum, and polyarthritis of multiple joints. What would the nurse document as an appropriate nursing diagnosis based on these findings?
a. Activity intolerance related to fatigue and arthralgia
b. Risk for infection related to open skin lesions
c. Risk for impaired skin integrity related to pruritus and scratching
d. Risk for impaired physical mobility related to permanent joint fixation
ANS: A
The clinical manifestations of rheumatic fever include fatigue and arthralgia.
The nurse establishes the nursing diagnosis of ineffective therapeutic regimen management related to lack of knowledge concerning long-term management of rheumatic fever when a patient recovering from rheumatic endocarditis makes which of the following remarks?
a. “I will have to take prophylactic monthly antibiotic injections for at least 5 years.”
b. “I should see my physician if I develop excessive fatigue or difficulty breathing.”
c. “I will need to let my dentist know that I have had this rheumatic fever.”
d. “I will be immune to further episodes of rheumatic fever after this infection.”
ANS: D
Patients with a history of rheumatic fever are more susceptible to a second episode.
The community health nurse involved in programs to prevent rheumatic fever knows that which of the following interventions is the most important to decrease the incidence of the disease?
a. Immunizing susceptible groups of people with streptococcal vaccine
b. Providing prophylactic antibiotics to people with a family history of rheumatic fever
c. Teaching people to seek medical diagnosis and treatment for streptococcal pharyngitis
d. Promoting hygienic measures to prevent the transmission of streptococcal infections
ANS: C
Prevention involves early detection and immediate treatment of group A β-hemolytic streptococcal pharyngitis. Adequate treatment of streptococcal pharyngitis prevents initial attacks of rheumatic fever.
