Practice Questions r/t Cardiac and Circulatory Concerns

Question 1

A client is admitted to the coronary care unit with c/o chest pain and nausea. Six hours after admission, the client tells the nurse, “ I need to have a bowel movement.” The most appropriate response by the nurse would be:

1. you need to walk slowly to the bathroom, I will assist you
2. I will see that a commode chair is brought to your bedside
3. you should avoid straining while having a bowel movement
4. wait until a prescription can be obtained for a Fleet enema

Answer 1

the client should be told that (3) straining at stool is discouraged. Straining initiates the Valsalva’s maneuver, which increases pressure in the large vein in the thorax and can interfere with the return of blood flow to the heart. the client should be provided with a bedpan to conserve energy.

clients admitted to CCU are placed on bedrest and should not walk to the bathroom.

until a definitive diagnosis is made, the client should not use a bedside commode chair

there is no indication that an enema is needed

Question 2

a client is admitted with a diagnosis of super-ventricular tachycardia with c/o dizziness and fatigue. In the presence of a rapid heart rate, the nurse will assess first for the development of:

1. fluid in the lungs
2. pallor
3. increasing urinary output
4. unstable angina

Answer 2

The nurse will assess the client for the development of fluid in the lungs, which may be manifested by the presence of crackles (also referred to as rales). Rapid heart rhythms may cause heart failure along with accumulation of fluid in the lungs

pallor (paleness of the skin) may be present, however, the nurse will assess the client for the most life-threatening possibilities, such as fluid accumulation in the lungs

urinary ouput will be decreased in the presence of heart failure, not increased. diminished cardiac output prevents an adequate supply of blood from reaching the body tissues and organs (low perfusion). low perfusion of the kidneys causes an abnormal reduction in urinary output (oliguria)

rapid heart rates are not always associated with unstable angina. however, fluid in the lungs is likely and life threatening

Question 3

your client is hypertensive and has been taking an ACE inhibitor for several days. Today’s prescribed medications include a loop diuretic. The expected outcome of this therapy is:

1. excretion of calcium with no diuretic effect
2. an increase in diastolic blood pressure
3. a decrease in blood pressure
4. hypotension

Answer 3

an expected outcome of loop diuretic therapy is a decrease in blood pressure. loop diuretics are often administered with angiotensin-converting enzyme inhibitors to manage hypertension. a diuretic reduces the circulatory volume by increasing renal excretion of water, sodium, chloride, magnesium, hydrogen, and calcium. an ACE inhibitor prevents the production of angiotensin II, a potent vasocontrictor. Therfore, by reducing circulatory volume and preventin vasocontriction, the blood presure can be lowered.

when a loop diuretic is administered, it inhibits the reabsorption of sodium and chloride by the nephron after they have been throug the glomerulus. the client will receive the benefit of the diuretic without the excretion of calcium

loop diuretics cause a decrease in diastolic blood preasure, not an increase

hypotention is a side effect of ACE inhibitors and diuretics, not an expected therapeutic outcome

Question 4

a client diagnosed with acute myocardial infarction develops pericarditis 4 days after admission to the hospital. Nursing assessment on the fifth day reveals c/o chest pressure, shortness of breath, increasing anxiety, and restlessness. Physical findings show diminished heart sounds and a mild friction rub. The nurse recognizes these symptoms as evidence of:

1. cardiac tamponade
2. pericardial effusion
3. increased cardiac output
4. cardiomyopathy

Answer 4

chest pressure, shortness of breath, anxiety, restlessness, diminished heart rate, and friction rub are all classic manifestations of pericrdial effusion (the accumultion of an abnormally large amount of pericardial fluid in the pericardiaum). Other symptoms of pericardial effusion include hypotension and elevated jugular vein distention

cardiac tamponade may follow pericardial effusion. symptoms of cardiac tamponade include increased intracardiac pressure, limitation of ventricular filing, reduction in stroke volume, jugular vein distention, a decrease in cardiac output, and increase in heart rate. the usual complaint is dyspnea

chest pressure, SOB, anxiety, restlessness, diminished heart sounds, and friction rub would cause a decrease in cardiac output, not an increase.

cardiomyopathy is a disease of the myocardium (the middle layer of the walls of the heart. Cardiomyopathy is characterized by impaired contractility and pumping ability of the heart

Question 5

your 55-year-old client is unresponsive and has a pulse that is barely palpable. The electrocardiogram has identified a supraventricular tachycardia of 180 beats per minute. you anticipate cardioversion by defibrillation with:

1. 20 joules
2. 50 joules
3. 200 joules
4. 500 joules

Answer 5

cardioversion by defibrillation with 50 joules is anticipated. treatment for symptomatic supraventricular tachycardia is cardioversion. Defibrillation with 50 joules is the appropriate dosage.

defibrillation with 20 joules is a pediatric defibrillation dose

defibrillation with 200 joules is indicated for ventriucular fibrillation or pulseless ventricular tachycardia

defibrillation with 500 joules is an inappropriately excessive dosage of current

Question 6

Which of the following statements are correct regarding coronary artery disease in women? (select all that apply

a. diabetes mellitus is a predictor of CAD in women
b. estrogen replacement in postmenopausal women reduces the risk of CAD
c. smoking cigarettes contributes to CAD in women
d. hypertension is not a risk factor for CAD in women
e. CAD is the number-one cause of death in American women

Answer 6

a, b,c,e
women with diabetes mellitus are 5-7 times more likely to develop CAD than women who don’t have DM

estrogen replacement in postmenopausal women may reduce risk of CAD by 50%. Estrogen replacement lowers LDL and raises HDL cholesterol

smoking is the biggest contributor to CAD in women under 50. nicotine causes vasoconstriction and can increase blood pressure

hypertension is a risk factor

Question 7

a client with generalized arteriosclerosis approaches the nurse and says, “ I don’t sleep well at night because my feet get cold. what should I do?”. Which of the following responses would be the most effective and safest recommendation?

1. rub your feet briskly to improve circulation
2. place a light blanket over your feet at night
3. place your feet on a covered hot waterbotle
4. put a covered heatingpad on your feet with the dial on the lowest setting

Answer 7

the nurse should recommed that the client cover the feet with a light blanket. this is the most effective and safest way to keep the feet warm

clints with arterioslcerosis are susceptible to thrombi formation. therefore, rubbing the feet is dangerous since it could cause the release of thrombi

clients with poor circulation may experience parensthesia (numbness and tingling) of the extremities. for this reason it would be unsafe to suggest the use of a hot water bottle or a heating pad

Question 8

a client with esophageal varices is experiencing hematemesis. A balloon tamponade has been inserted. the nurse recognizes that the primary purpose of this intervention is to:

1. apply pressure to the affected area
2. prevent paralytic ileus
3. provide a means for irrigating the stomach
4. prevent vomiting of blood

Answer 8

the primary purpose for the balloon tamponade is to apply pressure at the site of bleeding. Esophageal varics are dilated, tortuous veins that may bleed easily. this condition is usually caused by portal hypertension and is life threatening

a paralitic ileus is characterized by lack of bowel sounds and lack of peristalsis, accompanied by distention of the abdomen. the client may experience nausea and vomiting. fecal material may be vomited because of the potential for reverse peristalsis. this condition is treated with a nasogastric tube, not a balloon tamponade. paralitic ileus may occur folowing abdominal surgery or with the administration of certain psychotropic drugs

balloon tamponade does allow for gastric suctioning, however this is not the primary purpose. gastric suctioning is usually done to monitor bleeding

balloon tamponade will not prevent vomiting of blood. however, to preven aspiration of blood, an endotracheal tube is sometimes inserted

Question 9

a 3 y/o was hospitalized with congestive heart failure. the child had been digitalized and is now receiving a maintenance dose of digoxin 0.08 mg po bid. the available medication contains 0.05 mg digoxin per 1 cc of solution. How much of the solution will the nurse administer?

1. 0.06 cc
2. 0.6 cc
3. 1.6 cc
4. 2.6 cc

Answer 9

1.6 cc of the solution

Question 10

the most distinctive electrocardiogram change associated with hyperkalemia is:

1. absence of P waves
2. atrial fibrillation
3. heightened QRS complexes
4. peaked T waves

Answer 10

the most distinctive electrocardiogram change associated with hyperkalemia is an elevated T wave

the P wave represents atrial muscle depolorization. absence of the P wave is associated with conditions such as atrial flutter and ventricular fibrillation

atrial fibrillation is a dysrhythmia in which minute areas of the atrial myocardium are in uncoordinated stages of depolarization and repolarization. this is due to multiple reentry circuits within the atrial myocardium. when this occurs, the atria quivers continuously in a chaotic pattern

heightened QRS complexes are associated with ventricular hypertrophy. Ventricular hypertrophy is due to chronic pressure overload

Question 11

which assessment should be completed frequently on clients receiving Trildil?

1. blood pressure
2. blood glucose
3. breath sounds
4. urine output

Answer 11

Patients receiving nitroglycerin (Tridil) intravenously should have their BP monitored frequently. Tridil is the intravenous form of nitroglycerin. because of the vasodilating effects, the BP should be monitored for frequent side effect of hypotension

Tridil does not affect blood glucose and neither the respiratory or genitourinary system are directly affected by Tridil

Question 12

Atrial flutter may best be described as:

1. an irregular, chaotic ventricular rhythm
2. an irregular rhythm with little wave formation between QRS complexes
3. an atrial rhythm characterized by a sawtooth pattern between QRS complexes
4. a barely discernible rhythm, not associated with any heart muscle activity

Answer 12

atrial flutter is best described as an atrial rhythm characterized by a sawtooth pattern between QRS complexes. Atrial flutter occurs when the sinoatrial node is no longer the primary atrial pacemaker and an ectopic pacemaker resumes pacing. this ectopic pacemaker may have a very high rate, which is represented as a sawtooth patern on the ECG. the QRS complexes appear normal - but it has a very definite pattern between the QRS complexes. it is associated with heart muscle activity and there is a discernible rhythm.

Question 13

A client is receiving a continuous drip of nitroprusside sodium (Nitropress) to decrease cardiac afterload. What special precaution will the nurse take when administering this medication?

1. use special intravenous tubing
2. protect the solution from light
3. put medication in glass bottles only
4. do not allow solution to hang for more than 4 hours

Answer 13

When administering nitroprusside sodium (Nitropress), the nurse will need to protect the fluid from light by wrapping the infusion bottle in aluminum foil. Nitropress is a potent arterial/venous vasodilator that increases or decreases cardiac output depending on the extent of preload and afterload reduction

unlike Tridil, nitropress does not require special intravenous tubing. However, nitropress should only be mixed with distilled water

unlike Tridil, Nitropress does not require a glass bottle

Nitropress should no be let hanging for more than 24 hours

Question 14

Your client has an asymptomatic abdominal aortic aneurysm. Ultrasonographic examination indicates that the aneurysm is 3.5 cm. You anticipate:

1. administration of an antihypertensive medication
2. excision of the aneurysm with replacement of the excised segment with a synthetic graft
3. a gastrointestinal bleed that may progress to shock
4. a complaint by the client of intense back and flank pain with awareness of a pulsating mass in the abdomen

Answer 14

the nurse will anticipate administering an antihypertensive medication and scheduling ultrasonographic examination every 6 months to determine any changes in the size of the aneurysm.

surgery is not generally performed when an abdominal aortic aneurysm is less than 4 to 5 cm

gastrointestinal bleeding that produces shock is the presenting sign when an abdominal aortic aneurysm ruptures into the duodenum

clients do not have complaints if their abdominal aortic aneurysm is asymptomatic

Question 15

you are concerned that your client is getting too much digoxin. What signs and symptoms are indicative of digitalis toxicity?

1. convulsions
2. yellow-green halo vision
3. muscle cramping
4. orthostatic hypotension

Answer 15

signs and symptoms of digoxin toxicity include headaches, yellow-green halo vision, blurred vision, drowsiness, muscle weakness, anorexia, nausea, vomiting, diarrhea, and cardiac dysrhythmias

convulsions, muscle cramps, and orthostatic hypotension are not among the side effects of digoxin administration

Question 16

The nurse routinely obtains a client’s central venous pressure readings. Should interventions become necessary based on central venous pressure readings, they would be implemented for the purpose of:

1. maintaining a normal range of pressure in the right atrium
2. lowering the pressure in he pulmonary artery
3. detecting dysrhythmias in the left ventricle
4. promoting circulation through the aorta

Answer 16

the goal of any interventions based on central venous pressure (CVP) reading would be maintaining normal pressure in he right atrium. The CVP is an estimate of the pressure within the right atrium and provides information concerning the function of the right side of the heart. changes in CVP represent changes in blood volume and in the venous return to the right side of the heart

CVP readings don’t pertain to the pressure in the pulmonary artery. They will not detect dysrhythmias in the left ventricle. Nor will they promote circulation through the aorta (or indicate this need)

Question 17

A client is diagnosed with Raynaud’s phenomenon. When assisting the client to manage activities of daily living, the nurse should include which of the following in the teaching plan?

1. moving to a warmer climate
2. taking pain medication when exposed to cold or cold objects
3. wearing gloves when exposed to cold or cold objects
4. limiting activity to decrease metabolic demands upon the body

Answer 17

the nurse would recommend that the client who is experiencing Raynaud’s phenomenon wear gloves when exposed to cold or cold objects. Raynaud’s phenomenon is initiated by exposure to cold or occasionally by emotional disturbances/distress. It is characterized by intermittent attacks of pallor followed by cyanosis; then the digits become red and return to normal.

moving to a warmer climate may not be beneficial since symptoms may continue to occur in the cooler weather of warmer climates as well

medications used are focused on vasodilation, not relief of pain. Medications include Nifedipine (Procardia) and isoxuprine (Vasodilan)

Raynaud’s phenomenon is a vasospastic disorder of small cutaneous arteries that is self-limiting. Episodes last about 15 minutes, frequently involving the fingers, toes, and ear. Limiting activity is not necessary

Question 18

The foot of your client’s casted leg is mottled and warmer than the unaffected leg. You notify the physician immediately because you suspect:

1. arterial insufficiency
2. venous insufficiency
3. compartmental syndrome
4. fat emboli

Answer 18

the nurse will suspect venous insufficiency and will notify the physician. With venous insufficiency, the casted limb feels warmer than the uncasted limb and appears bluish or mottled in colour

the hallmark of arterial insufficiency is intermittent claudication, experienced as a sharp, unrelenting, constant pain

compartment syndrome occurs when a structure such as a nerve or tendon is constricted into a space, as in carpal tunnel syndrome. Symptoms include throbbing pain out of proportion to the original condition or injury, pain that is not relived by analgesics, pain experienced when flexing or extending the affected body part

a fat embolus produces symptoms that include hypoxia, tachycardia, dyspnea, and pallor

Question 19

Which of the following symptoms is characteristic of intermittent claudication?

1. extensive discoloration
2. dependent edema
3. pain associated with activity
4. petechiae

Answer 19

pain associated with activity is characteristic of intermittent claudication. The pain is caused by inadequate arterial circulation to contracting muscle. Severe pain occurs when walking and subsides with rest. The inadequate blood supply may be due to arterial spasm, atherosclerosis, arteriosclerosis, or an occlusion.

Extensive discolouration, dependent edema, and petechial are not characteristic of intermittent claudication

Question 20

A client experiencing stage II hypertension may be treated with which of the following medications?

1. levothyroxine
2. phenytoin
3. cefprozil
4. metoprolol

Answer 20

a client with stage II hypertension may be treated with metoprolol (Lopressor). Metoprolol inhibits a portion of the sympathetic nervous system and reduces myocardial contractility, heart rate, and blood pressure. This medication belongs in the group of medications called beta-blocker, used to treat hypertension and arrhythmias. Stage II hypertension is hypertension with blood pressures of 160-170 mmHg systolic and 100-109 mmHg diastolic. These pressures are typically treated medically.

Levothyroxine (synthroid) is a thyroid hormone replacement and does not impact hypertension

phenytoin (Dilantin) is a n anticonvulsant and does not impact hypertension

cefprozil (cefzil or cefproxil) is a second generation cephalosporin and does not impact hypertension

Question 21

you client has thromboangiitis obliterans. You are teaching the client how to participate in the treatment of this condition. Which statement by the client indicates a need for further teaching?

1. It will be helpful if I can find employment that allows me to sit most of the time
2. I know it’s essential that I quit smoking
3. I intend to walk 30 minutes twice daily
4. I’ll need to be careful that I don’t injure my legs

Answer 21

The nurse will teach the client that sitting or standing in one position for long periods of time is not recommended, since this contributes to venous stasis. Thromboangiitis obliterans (Buerger’s disease) is characterized by inflammation of the small and intermediate arteries and veins. It results in the formation of thrombi and eventually occlusion of the vessels

Clients with Buerger’s disease should absolutely not use tobacco in any form. Research indicates that heavy smoking is either a causative or a contributive factor. cigarette smoking causes arterial constriction and increases platelet adhesion, which leads to thrombus formation

walking is advisable and helps prevent stasis of blood flow

clients with Buerger’s disease should avoid injury to the extremities because of the likelihood of infection due to poor circulation

Question 22

The nurse is observing a client for symptoms of postoperative shock. The earliest symptom of postoperative shock would be obtained by monitoring the:

1. pulse rate
2. pulse pressure
3. temperature
4. respirations

Answer 22

The nurse will monitor the client’s pulse rate for signs of postoperative shock. The earliest sign of shock is a pule rate that steadily increases over time. An increase in the heart rate is an attempt to compensate for a decrease in cardiac volume

pule pressure is the difference between the diastolic and systolic pressure. The pulse pressure would drop if a client were in shock. However, a drop in pulse pressure would not be the earliest sign

body temperature refers to the balance between the heat produced by the body and the heat lost by the body. A drop in body temp would not be the first sign of shock

respirations would increase in response to postoperative shock, but this would not be the first sign.

Question 23

A client with hypertension is receiving the angiotensin-converting enzyme inhibitor enalapril to decrease blood pressure. The nurse understands that this medication lowers blood pressure by:

1. promoting vasodilation
2. blocking beta-adrenergic impulses
3. inhibiting angiotensin-converting enzyme
4. preventing reabsorption of sodium chloride

Answer 23

ACE inhibitors such as enalapril (Vasotec) decrease blood pressure by inhibiting the angiotensin-converting enzyme. Therefore, angiotensin (a potent vasoconstrictor) is not released

vasodilators such as hydralazine hydrochlorize (apresoline) and diazoxide (hyperstat) act primarily on smooth muscle of arterioles to cause vasodilation

beta-adrenergic blockers like propranolol hydrochloride (Inderal) decrease the blood pressure by blocking the beta-adrenergic impulses

diuretics such as furosemide (Lasix) block the reabsorption of sodium and chloride and thus decrease the fluid volume and BP

Question 24

A 65-year-old take 0.125 mg of dioxin po qid. Which condition could predispose the client to develop digitalis toxicity?

1. pneumonia
2. hyperkalemia
3. hypothyroidism
4. hypocalcemia

Answer 24

hypothyroidism affects the body’s ability to metabolize digitalis and predisposes a client to digitalis toxicity

pneumonia does not affect the body’s ability to metabolize digoxin

hypokalemia (not hyperakalemia) and hypercalcemia (not hypocalcemia) predispose a client to digitalis toxicity

Question 25

A client complaining of severe substernal pain is presently being seen in the ED. An acute anterior myocardial infarction is suspected. An elevation of which enzyme would confirm the diagnosis a this time?

1. creatine kinase (CK) and its isoenzyme CK-MB
2. CK and its isoenzyme CK-MM
3. lactic dehydrogenase (LDH2)
4. serum glutamic-oxaloacetic transaminase (SGOT)

Answer 25

an elevation of CK and CK-MB (which is the isoenzyme of CK associated with the cardiac muscle and found there almost exclusively) is the best indication of myocardial damage within the first 2 to 3 hours following an acute ischemic event.

CK-MM is the isoenzyme associated with skeletal muscle and indicates damage of skeletal muscle, not myocardial damage

an elevation of LDH1 and LDH2 is indicative of myocardial necrosis. approximately 80% of clients show an increase of theses enzymes within 48 hours of an MI

SGOT is found in the liver and, to some extent, in the skeletal muscle - not helpful in confirming damage to myocardium

Question 26

Which of the following laboratory value combinations is most likely to represent the client with the least risk of heart disease?

1. a high-density lipoprotein (HDL) of 70 mg/dl and a low-density lipoprotein (LDL) of 110 mg/dl
2. a HDL of 30 mg/dl and a LDL of 110 mg/dl
3. a HDL of 30 mg/dl and a LDL of 140 mg/dl
4. a HDL of 70 mg/dl and a LDL of 140 mg/dl

Answer 26

laboratory values with the least risk for heart disease would be a HDL of 70 mg/dl and a LDL of 110. HDL, although a form of cholesterol, tend to bind with LDL, thereby lowering total cholesterol levels. HDL levels above 35 mg/dl are desirable. LDLs contribute to elevated total cholesterol level and levels < 130 mg/dl are most desirable

Question 27

Your client is experiencing an evolving myocardial infarction and is being evaluated for thrombolytic therapy. Which statement made by the client would constitute a possible contraindication for this treatment?
1, I’ve been having chest pain for 2 hours
2. I’m feeling really nauseated right now
3. I’ve been taking blood pressure medicine for years
4. I’m still taking medication for my stomach ulcers

Answer 27

clients with stomach ulcers may not receive thrombolytic therapy. Thrombolytic therapy is the administration of medications specifically designed to dissolve blood clots. Muscle damage associated with arterial blockage by blood clots has been completely avoided wit the use of these medications. Because they affect blood viscosity and clotting mechanisms, possible contraindications include disorders that are hemorrhagic in nature. Bleeding ulcers, recent surgeries, blood dyscrasias, and aneurysms are examples of disorders that may contraindicate such treatment

antithrombolytic therapy has been found to be very successful if administered early on in the course of the event

nausea is not an uncommon symptom associated with evolving myocardial infarction and would not prevent a client from receiving antithrombolytic therapy

persons who take antihypertensives may receive thrombolytic therapy if not otherwise contraindicated

Question 28

A client experiencing coronary artery disease may be treated with all of the following medications. Which medication will the nurse recognize as a calcium channel blocker?

1. metoprolol
2. nifedipine
3. nitroglycerin
4. aspirin

Answer 28

Nifedipine (Procardia) is a calcium channel blocker. Calcium channel blockers tend to inhibit the flow of calcium ions across cell membranes. This class of drug is specific for cardiac tissue and decreases excitability of cardiac tissue. As a result, the heart rate decreases and blood pressure drops

metoprolol is a beta-blocker

nitroglycerine (nitrostat) is an antianginal vasodilatory medication

aspirin is an antipyretic analgesic with antiplatelet activity

Question 29

a 7-month-old infant with tetralogy of Fallot is in the recovery room following a right heart catheterization. Which of the following assessment findings should be reported immediately?

1. an apical pulse of 74 beats per minute
2. the left foot cool to the touch
3. mild clubbing of fingers and toes
4. irritable when dressing is changed

Answer 29

an apical pulse of 74 beats per minute is too low for an infant 7 months old and should be reported immediately. Cardiac catheterization can result in dysrhythmia or rates that are too slow or too fast. This may occur because of temporary or permanent damage to conduction system

access to vessels would have been in the right femoral area. Coolness of the left foot is most likely related to environmental temp, not catheterization

clubbing is not related to catheterization. related to cardiac defect and usually develops slowly are result of hypoxia to distal tissues

7 month old children may be upset by procedures, strangers, or being forced to do something (like stay still for a dressing change)

Question 30

A client is returned to the unit following a angiocardiography. Which nursing action is appropriate at this time?

1. discourage fluid intake and place client in a prone position
2. apply heat to puncture site and passively exercise the involved extremity
3. limit motion of the affected extremity and assess the puncture site
4. restrict fluid intake and encourage ambulation

Answer 30

the nurse will limit the motion of the affected extremity and assess the puncture site. The client is at risk of hemorrhage from the puncture site following an angiocardiography

fluid intake should be encouraged to flush out the radiopaque dye used in the angiocardiogaphy. however, the client should be placed in a supine position with the affected leg straight and the head elevated no more than 30 degrees

application of heat would facilitate hemorrhage as would passive exercise - should be avoided

ambulation is contraindicated due to likelihood of hemorrhage at the puncture site. the site needs time to heal

Question 31

an adult client was admitted to the coronary care unit following a subendocardial myocardial infarction. A balloon-tipped pulmonary artery catheter was inserted when the client began to exhibit signs of cardiogenic shock. The nurse measures the client’s pulmonary capillary wedge pressure and finds it to be 18 mmHg. The nurse knows this pressure is:

1. within normal limits
2. elevated above normal
3. less than normal
4. life threatening

Answer 31

.the nurse will recognize a capillary wedge pressue of 18 mmHg iselevated (normal is 5 to 12 mmHg). The higher the pressure, the more severe the heart failure. Pressures that exceed 23 to 30 mmHG are associated with pulmonary edema.

at this point, the pulmonary capillary wedge pressure is considered elevated. However, if it should continue to rise, it would become life threatening

Question 32

Your client’s cardiac monitor displays a dysrhythmia - there is an irregular rhythm with no identifiable P waves. The client’s blood pressure is 110/70 mmHg, the pulse rate is between 120 and 140 beats per minute, and the respiratory rate is 18 breaths per minute. The client is alert, oriented, and complaining of palpitations and fatigue. The nurse will anticipate the administration of:

1. lidocane
2. atropine
3. digitalis
4. pronestyl

Answer 32

.the nurse will andticipate the administration of digitalis. The rhythm depicts atrial fibrillation. It is characterized by an irregular rhythm with no identifiable P waves

lidocaine aka zylocain is administered to treat ventricular tachycardia

atrpine aka atropair increases the heart rate. therefore, it would not be administer, since the client’s heart rate is already fluctuating between 120 and 140 beats per minute. Atropine is administered for slow rhythms

procainamide aka pronestyl is frequently indicated for ventricular dysrythmia, not atrial dysrhythmia

Question 33

A 64 y.o. client in the intensive coronary care unit is experiencing a dysrhythmia. The strip shows an oscillating wave (it looks like a scribble up and down). It is approximately the height you’d expect a QRS complex to be. The client is hemodynamically stable. You anticipate the administration of

1. digoxin
2. inderal
3. lidocaine
4. verapamil

Answer 33

lidocaine aka xylocaine aka zylocain is the drug of choice for clients experienceing ventriular tachycardia and are hemodynamically stable

digoxin aka lanoxin is the drug of choice for atrial fibrillation

propanolol aka inderal and verapamil aka calan are administered for supraventricular tachycardia

Question 34

An ECG strip shows a p wave for every QRS and a regular rhythm. There are 13 R waves on the six second strip. The nurse will recognize the strip as an example of

1. a normal sinus rhythm
2. sinus tachycardia
3. ventricular tachycardia
4. atrial fibrillation

Answer 34

the nurse will recognize the rythm strip as an example of sinus tachycardia. There is a p for every qrs, a regular rhythm, and PR and QRS intervals are within normal limits. only abnormality is rate, which is high. Normal rate is between 60 and 100, sinus tachycardia is between 100 and 150

ventricular tachycardia is characterized by 3 or 4 consecutive premature ventricular contraction

atrial fibrillation is chraacterized by an irregular rhythm with no identiable P wave

Question 35

An ECG strip shows two normal sinus rhythm waves and then shortly after the T wave of the second, a depolarization, approximately the height of the previous two QRS complexes, but more than twice as wide occurs. Afterwards a normal appearing wave occurs again. This strip is an example of:

1. a second-degree AV block, type II
2. premature junctional contractions
3. premature ventricular contractions
4. third-degree AV block

Answer 35

The rhythm strip is an example of premature ventricular contraction. The PVCs are characterized by wide, bizarre QRSs, no associated P wave proceeding the QRS complex, and the T waves are in the opposite direction from the QRS deflection

second-degree AV block type II results in intermittently dropped QRS complexes with normal-appearing P waves occuring at regular intervals

premature junctional contractions are characterized by upward impulses from the AV junction to the atria; thus in lead II, the P waves are inverted and the PR interval shortens to 0,12 seconds

in third-degree AV block, all impulses from the atria are blocked, resulting in complete dissassociation of the atria and ventricles, causing differences in heart rate and QRS duration

Question 36

A client in the Intensive Coronary Care Unit develops a dysrhythmia. The ECG strip shows a small, irregular oscillating wave. What should be done immediately?

1. cardioversion
2. defibrillation
3. administration of lidocaine
4. administration of sodium bicarbonate

Answer 36

the immediate treatment is defibrillation. The dysrhythmia depicted is ventricular fibrillation. This is characterized by a bumpy line of unidentifiable waves. This is a life-threatening dysrhythmia, and without prompt treatment, death will occur.

cardioversion cannot be performed because it requires that electric shock be correlated with the QRS complex, and there is no QRS complex with Vfib.

lidocaine is utilized for ventricular tachycardia and frequent PVCs. After defibrillation and restoration of a rhythm, a lidocaine drip will probably be initiated to decrease the irritability of the myocardium, but first the rhythm must be converted out of ventricular fibrillation

sodium bicarbonate is administered to correct acidosis that occurs with cardiac arrest. It will probably be given to a client with ventricular fibrillation, but again, the client needs to be defibrillated first

Question 37

A six-second ECG strip shows 10 R waves. P waves are rounded and smooth, uniform in shape to one another, and there is one for each QRS complex. T waves are present. No U wave is noted. Based on this information, what will this rhythm be documented as?

1. sinus tachycardia
2. sinus bradycardia
3. first-degree block
4. normal sinus rhythm

Answer 37

the electrocardiograph will be documented as normal sinus rhythm.

Question 38

The ECG shows p waves and QRS complexes,
however T waves go down instead of up. At end of strip, there is a long flattened section. this is an example of which dysrhythmia?
1 first-degree AV heart block
2. second-degree AV heart block, type I
3. second-degree AV heart block, type II
4. third-degree AV heart block, type III

Answer 38

this strip depicts second-degree AV block, type I. This dysrhytmia is characterized by a PR interval that progressively lengthens until a P wave is not followed by a QRS complex

first degree AV block is characterized by a PR interval greater than 0.2 seconds

second degree AV block, type I is characterized by nonconducted sinus impulses despite constant PR intervals

in third-degree block, entire sinus or atrial impulses are blocked and the atria and ventricles are forced to beat independently

Question 39

Sinus tachycardia may best be described by which of the following?

1. a chaotic rhythm with no discernible pattern that is not associated with cardiac output
2. a regular rhythm with rate greater than 100 beats per minute
3. a ventricular rapid rhythm that may or may not produce a palpable pulse
4. a regular rhythm with rates between 60 and 100 beats per minute

Answer 39

sinus tachycardia may best be described as a regular rhythm with a rate greater than 100 beats per minute. Sinus tachycardia originates in the sinus node and follows the normal conduction pathways through the ventricles. In the adult client, the parameters of sinus tachycardia is generally considered to be between 100 and 150 bpm. Rates higher than 150 bpm are not thought to originate from the sinoatrial node, but from an ectopic site above the ventricles - supraventricular tachycardia

a chaotic rhythm with no cardiac output is likely ventricular fibrillation

a ventricular rhythm with variable output is likely ventricular tachycardia

a regular rhythm with rates between 60 and 100 are usually considered normal sinus rhythm for adults

Question 40

sinus bradycardia is best described as:

1. an irregular rhythm of ventricular origin with faint, if any, palpable pulse
2. an irregular, slow ventricular rate with variable numbers of P waves between complxes
3. a normal rhythm with a rate of less than 60 beats per minute
4. a normal rhythm with a rate of more than 100 beats per minute

Answer 40

sinus bradycardia is best described as a normal rhythm with a rate of less than 60 beats per minute. It originates from the sinus node and follows the regular conduction pathways through the ventricles. in the adult client rates less than 60 ar bradycardic.

an irregular ventricular rhythm would describe an idioventricular or ventricular rhythm

an irrecular ventricular rate with variable numbers of P waves between complexes describes a complete, or third-degree heart block

a normal rhythm with a rate greater than 100 BPM describes sinus tachycardia

Question 41

Which of the following instruction should be given to a client who has Nitrostat on hand for treatment of angina?

1. keep your medication in the refrigerator at all times
2. replace your tablets every 8 months
3. swallow your pill with a big glass of water, not milk
4. if your angina is not relieved after 3 pills, come to the emergency department

Answer 41

as a rule, chest pains that are not relieved by 3 doses of nitroglycerin should be evaluated by a physician for myocardial ischemia or infarction

nitroglycerine should be kept with clients and should be accesible at all time. Protection from extreme temperatures is usually adequate storage

nitroglycerin is typically replaced 6 months after opening

this medication is to be taking via sublingual route, not swallowed

Question 42

Nursing measures that include instructing clients in the prevention of coronary artery disease are referred to as:

1. primary interventions
2. acute-care interventions
3. secondary interventions
4. tertiary intervntions

Answer 42

primary interventions contribute to prevention of a disease process. Examples include immunizations against disease and teaching wellness.

acute or secondary focus on diagnosis and treatment of disease

tertiary interventions focus on rehabilitation from disease process

Question 43

A client who is taking daily digoxin says to you, “I have been experiencing nausea”. Upon further inquiry, it is discovered that the client’s pulse rate is 52 beats per minute. The nurse should instruct the client to:

1. double the digoxin dose
2. take an antacid 1 hour prior to today’s digoxin dose
3. take the digoxin on an empty stomach, but with a full glass of water
4. hold digoxin dose and come to the clinic for evaluation

Answer 43

a client with a pulse rate of 52 bpm and nausea should hold their dose and come into office or hospital for evaluation. Digoxin is a cardiac atiarrhythmic with positive inotropic qualities - meaning it regulates and strengthens the heart’s contractions. Digoxin toxicity is a risk for anyone taking this medication as it has a narrow therapeutic range. Signs and symptoms of toxicity include nausea, dizziness, visual disturbances, bradycardia, and other arrhytmias

no more digoxin should be taken

antacids are not recommended in this situation as they could mask symptoms

Digoxin, when taken, should be taken on an empty stomach.

Question 44

A client who has a 12-lead electrocardiogram tells you there was a premature ventricular contraction noted by the technician taking the ECG. Your response to your client’s concern about this based on the knowledge that:

1. PVCs may be benign
2. there are no lifestyle changes to decrease their incidence
3. PVCs are a prelude to lethal arrhythmias
4. PVCs indicate myocardial infarction

Answer 44

PVCs may be benign contractions that originate from ventricles, rather than atria, and are early in the cycle. They are usually wide and rather bizarrely shaped. It is not uncommon to notice a rare PVC in a client with no cardiac pathology.

PVCs may be caused by substances that increase sympathetic tone like caffeine or nicotine

PVCs can be symptomatic, but may be benign

those having an MI may have PVCs, however all those having PVC are not necessarily experiencing an MI

Question 45

Risk factors for primary (essential) hypertension include:
(select all that apply)
a. age
b. low serum lipids
c. race
d. diabetes mellitus
e. active lifestyle

Answer 45

a, c, d

approximately 50% of people over the age of 65 are experiencing hypertension and some ethnicities/races have higher liklihood of experincing hyperension

high serum levels and inactive/sedentary lifestyle is are associated with htn, not the opposite!

Question 46

Your client was brought to the emergency department following a myocardial infarction. Morphine sulfate IV has been prescribed. You understand this medication will decrease the cardiac workload by: (select all that apply)

a. increasing myocardial oxygen consumption
b. reducing contractility
c. lowering blood pressure
d. increasing the heart rate
e. decreasing pain

Answer 46

b & c

morphine sulfate administered IV will decrease cardiac workload by reducing contractility. it will lower blood pressure and therby decrease cardiac workload. It is very important to monitor the vital signs of clients receiving morphine because hypotension and bradycardia are adverse reactions

morphine sulfate would reduce, not increase, oxygen consumption (decreased myocardial oxygen consumption decreases cardiac workload too)

it will reduce, not increase heart rate (also decreasing workload)

it is an analgesic, but does not directly lower oxygen consumption by treating pain

Question 47

which of the following do you recognize as risk factors associated with sudden cardiac death?

a. hypercholesterolemia
b. coronoary artery disease
c. hypotension
d. cigarette smoking
e. female gender

Answer 47

a, b, d

male gender is a risk factor, not female

Question 48

the contraction phase of the cardiac cycle is referred to as the: _______________________

Answer 48

systole. during systole, myocardial fibers shorten, making heart chambers smaller, fprcing blood out