unit 7 Flashcards
A nurse is working with multiple heart patients in the critical care unit. What information in the patients charts would indicate intra-aortic balloon pump (IABP) counterpulsation? Select all that apply.
A) Cardiogenic shock subsequent to acute myocardial infarction
B) Low cardiac output following cardiac surgery
C) Unstable angina
D) Congestive heart failure and an incompetent aortic valve
E) Severe peripheral vascular disease
F) Aortic aneurysm
a b c
A patient with cardiac failure is being prepped to receive a ventricular assist device for circulatory support. What procedure should the nurse expect the patient to undergo in the future?
A) Intra-aortic balloon pump counterpulsation
B) Heart transplantation
C) Coronary artery bypass graft surgery
D) Percutaneous transluminal coronary angioplasty
b
A nurse working with a patient with a Novacor ventricular assist device (VAD) for long-term circulatory support recognizes that this patient is at risk for thromboembolic events. Which of the following is the best intervention for this patient?
A) Heparin infusions indefinitely
B) Warfarin therapy initially, which is gradually replaced by heparin infusions
C) Warfarin therapy indefinitely
D) Heparin infusions initially, which is gradually replaced by warfarin therapy
d
What should the nurse include in the plan of care for a patient being prepared for electrical cardioversion? Select all that apply.
A) Obtain informed consent from the patient.
B) Encourage the patient to eat a meal shortly before the procedure.
C) Record a 12-lead ECG and vital signs.
D) Turn off the synchronizer mode button.
E) Smear electrode gel between the two paddles on the chest.
F) Sedate the patient.
A C F
A nurse is caring for a patient during radiofrequency ablation. What nursing interventions would most likely put the patient at ease?
A) Communicating with the patient about the progress of the procedure
B) Connecting the patient to a cardiac monitor
C) Placing a lead apron under the patients lower back
D) Establishing a sterile field
A
A patient is being evaluated for possible permanent pacemaker implantation. Which of the following would be the best indication for permanent pacemaker implantation in this patient?
A) Myotonic muscular dystrophy with any degree of atrioventricular (AV) block
B) Asymptomatic sinus node dysfunction
C) Chronic, intermittent complete (bifascicular) heart block
D) Transient AV block after acute myocardial infarction (MI)
C
A patient requires a pacemaker that will pace his atria, sense electrical activity in his atria, and inhibit the response to sensed events. Which mode of pacemaker would he need?
A) ADD
B) VVI
C) AAI
D) VDD
C
A patient who had a transvenous pacemaker placed in the subclavian vein 24 hours ago is experiencing pleuritic pain, hypotension, and respiratory distress. What complication does the nurse suspect in this patient?
A) Perforation of ventricular wall
B) Pneumothorax
C) Lead dislodgment
D) Phlebitis
B
A patient is experiencing a malfunction with his permanent implanted pacemaker, and the nurse is examining his electrocardiogram strip. The patients pacemaker has a ventricular unipolar catheter and is in VVI mode. Which of the following findings should the nurse be most concerned about?
A) Pacing spikes absent
B) Pacing spike followed by a QRS complex
C) Tall pacing spikes
D) A narrow QRS
A
What information should the nurse include when teaching a patient with incessant ventricular fibrillation who is being considered for an implantable cardioverter-defibrillator (ICD)?
A) An ICD would be beneficial for this patient.
B) An ICD would be reasonable to consider for this patient.
C) An ICD may be considered but is questionable for this patient.
D) An ICD would not be useful and may even be harmful for this patient.
D
The physician has ordered fibrinolytic agents for a patient with coronary artery disease. What patient diagnosis would the nurse most expect?
A) Posterior wall acute myocardial infarction
B) Acute coronary syndrome without ST segment elevation
C) Acute ST segment elevation myocardial infarction
D) New onset of right bundle branch block
C
The patient is receiving an intravenous drip of lidocaine hydrochloride to suppress ventricular arrhythmias. During repositioning of the patient, the intravenous tubing is dislodged from the pump and the patient receives a bolus of approximately 300 mg. The nurse stops the drip temporarily. What is the best nursing action to take next?
A) Observe closely for hallucinations and hypotension.
B) Reconnect drip at ordered rate per minute.
C) Administer intravenous magnesium sulfate.
D) Complete unusual occurrence report form.
A
A patient calls emergency services with complaints of crushing chest and left shoulder pain. He should be instructed to:
A) Take 325 mg acetaminophen.
B) Take 325 mg of aspirin.
C) Take an antacid.
D) Drive to the ED.
B
The patient is receiving a positive inotropic drug by intravenous drip. If this therapy is effective, what physical change would the nurse most expect to find?
A) New-onset extra heart sound S3
B) Increasing peripheral edema
C) Increased urine output per hour
D) Basilar pulmonary crackles
C
A patient who has had an acute ST segment elevation myocardial infarction (STEMI) is started on an angiotensin-converting enzyme (ACE) inhibitor drug. In explaining the action of this drug to the patient, what is the best rationale for the nurse to use?
A) Most patients with acute myocardial infarction also have hypertension.
B) Reduction of afterload reduces stress on the damaged heart and further damage.
C) Use of ACE inhibitors is part of protocol for treatment of a STEMI.
D) ACE inhibitor therapy is not effective for other types of heart disease.
B
The patient is being evaluated for antihyperlipidemic therapy. The patient has two active risk factors for coronary artery disease. The nurse expects that this therapy will be initiated if which patient criteria are present?
A) Total cholesterol less than 200 mg/dL
B) Low-density lipoprotein greater than 160 mg/dL
C) High-density lipoprotein less than 40 mg/dL
D) Low-density lipoprotein less than 70 mg/dL
B
The patient is scheduled to undergo a percutaneous cardiac intervention (PCI). What patient history would the nurse least expect to find?
A) Poor left ventricular function and ejection fraction
B) Coronary artery lesions less than 70% narrowing
C) Extreme old age with fragility
D) Unstable angina with activity and at rest
B
. A female patient has just undergone a percutaneous coronary intervention (PCI). What symptom, if found by the nurse, requires immediate intervention?
A) Three premature ventricular complexes
B) Frank bleeding from the femoral insertion site
C) Serum potassium level 4.8 mEq/L
D) Hemoglobin 11.7 g/dL
B
. The patient has undergone a percutaneous coronary intervention (PCI) for relief of coronary stenosis secondary to arteriosclerotic heart disease. During discharge teaching, what patient statement most indicates the need for reteaching?
A) This procedure means that my heart disease is cured.
B) I should continue to take my antilipidemic.
C) If I have any chest pain, I will call my doctor.
D) I will start a walking program after my doctor agrees.
A
. The patient is scheduled for a percutaneous balloon valvuloplasty (PBV). What would the nurse most expect to find in the patient history?
A) Acute myocardial infarction
B) Increased serum troponin
C) Stenotic cardiac valves
D) Severe peripheral edema
C
A patient is being treated with the intra-aortic balloon pump (IABP). What effect of the balloon is most important?
A) Reduction of left ventricular workload
B) Improvement in right ventricular perfusion
C) Reduction of right ventricular preload
D) Minimal compromise of cardiac output
A
The patient is receiving intra-aortic balloon pump (IABP) counterpulsation. What is an indication for this therapy?
A) Hypotension after ST elevation myocardial infarction refractory to other therapy
B) High cardiac output in cardiogenic and other acute shock syndrome states
C) Right-sided congestive heart failure refractory to other therapy
D) Routine recovery from coronary artery bypass surgery in low-risk patients
A
The nurse is caring for a patient undergoing intra-aortic balloon pump (IABP) counterpulsation. What patient symptom most requires immediate nursing intervention?
A) Patient complains of stiffness in insertion leg.
B) Mean arterial blood pressure is increased by 10 points.
C) Balloon is inflating during ventricular systole.
D) Cardiac output is increased by 3 L/min.
C
. The patient has a newly inserted VVI pacemaker set at a demand rate of 70. What cardiac monitor reading, if found by the nurse, most indicates a pacemaker malfunction?
A) Patient pulse is 75 with no pacing stimuli seen on cardiac monitor.
B) Patient pulse is 70 with pacing stimulus seen before each R wave.
C) Patient pulse is 65 with no pacing stimuli seen on cardiac monitor.
D) Patient pulse is irregular with pacing stimuli seen before some R waves.
C
The patient has just had a transvenous cardiac pacemaker lead inserted into the subclavian vein. What patient symptom, if found by the nurse, would most indicate a possible complication unique to the use of the subclavian vein?
A) Persistent hiccups at the same rate as the pacemakers set rate
B) Sudden respiratory distress, hypoxia, and hypotension
C) Persistent premature ventricular complexes seen on cardiac monitor
D) Oversensing, undersensing, or failure to capture
B
A patient has a permanent pacemaker and complains of redness and swelling over the site of the generator implantation. The patient also has fever and leukocytosis. What is the most appropriate nursing action?
A) Assess for any patient action causing pressure on the site.
B) Assure the patient that these are signs of normal healing.
C) Ensure that pacemaker is working correctly.
D) Facilitate administration of intravenous antibiotics
D
- A patient has had an alkali splash causing burns to the right upper extremity and the right side of the face. Which intervention by the nurse is a priority?
A) Obtain a health history.
B) Irrigate with water to the burned area.
C) Apply an antibiotic cream.
D) Start an intravenous line (IV) of normal saline at 10 mL/hr.
B
A patient arrived in the emergency department (ED) after being found by a family member unconscious in the garage with the car running. High flow oxygen at 100% is administered in the ED. The nurse knows that which of the following diagnostic tests would be the best to determine that the present therapy is effective?
A) Pulse oximetry
B) Chest x-ray
C) Serial carboxyhemoglobin levels
D) Hemoglobin and hematocrit
C
A patient has been treated for severe burns over 36% of the body. What assessment data obtained by the nurse indicates the patient may be experiencing septic shock? Select all that apply.
A) White blood count (WBC) 7,200
B) Blood pressure 60/40
C) PaO2 72
D) Urine output <10 mL/hour
E) Blood pressure 140/76
B C D
The nurse is caring for a patient 24 hours after fluid resuscitation for burns over 50% of the body. Which assessment data obtained by the nurse indicates complications from the fluid resuscitation?
A) Absent peripheral pulses
B) Crackles in lung fields
C) Sinus bradycardia
D) 1+ pitting edema of the feet
B
