Cardiac Flashcards
A patient reports chest pain. Which questions related to the patient’s history are most important to ask? Select all that apply.
a. How would you describe your symptoms?
b. Are you allergic to any medications or foods?
c. Do you have any children?
d. How did your mother die?
a, b, d.
patient’s history.
patient’s symptoms before and during admission.
FMHx
current drug, OTC, herbs, illicit drug use.
Drug and food allergy.
The nurse is performing an assessment for an older adult patient with reports of chest pain. What assessment finding correlates with a potential age-related change?
a. A heart rate of 92 bpm
b. A progressive decrease in systolic blood pressure.
c. The presence of an S4 sound.
d. A shortened pulse pressure
c. the presence of an S4 sound.
As we age:
1. HR decrease
2. Heart block can occur.
3. presence of S4
4. pulse pressure widen
5. increase systolic pressure
A nurse is performing a cardiac assessment on an elderly patient. Which finding warrants further investigation?
a. Fourth heart sound (S4)
b. Increased PR interval
c. Orthostatic hypotension
d. Irregularly irregular heart rate
d. Irregularly irregular heart rate.
Irregularly irregular HR ==> Afib –> need further assessment.
It is normal for older adult to have:
1. S4 sound (prolonged systole)
2. increase PR interval (slow conduction)
3. Orthostatic hypotension (decrease baroreceptors response)
The nurse is caring for a geriatric client. The client is ordered Lanoxin (digoxin) tablets 0.125mg daily for a cardiac dysrhythmia. Which of the following assessment considerations is essential when caring for this client?
a. Digoxin level
b. Cardiac output
c. Activity level
d. Dyspnea
a. Digoxin level.
Digoxin increase cardiac contractility which slows and strengthen the heart rate.
Pulse rate must check before administration. In older adult, renal function also decrease. This increase the risk of digitalis toxicity. The nurse need to check serum digoxin periodically.
Cardiac output, activity level, and dyspnea should be monitored for the effectiveness of the drugs.
The nurse is performing an intake assessment on a patient with a new diagnosis of coronary artery disease. What would be the most important determination to make during this intake assessment?
a. Whether the patient and involved family members understand the role of genetics in the etiology of the disease.
b. Whether the patient and involved family members understand dietary changes and the role of nutrition.
c. Whether the patient and involved family members are able to recognize symptoms of an acute cardiac problem and respond appropriately.
d. Whether the patient and involved family members understand the importance of social support and community agencies.
c.
The most important information the nurse wants the patient to know is the signs and symptoms of acute coronary syndrome or heart failure and what to do. Knowing this may save patient’s life. All other actions are for education which is less important in this case.
The nurse cares for a patient with clubbing of the fingers and toes. The nurse should complete which action given these findings?
a. Obtain an oxygen saturation level.
b. Assess the patient’s capillary refill.
c. Assess the patient for pitting edema.
d. Obtain a 12-lead ECG tracing.
a.
clubbing of the fingernails and toenails are signs of chronic hemoglobin desaturation.
It could be due to congenital heart disease of COPD.
Prior to reaching the target heart rate, a client develops chest pain during an exercise stress test. What is the nurse’s appropriate response?
a. Administer sublingual nitroglycerin to allow the patient to finish the test.
b. Initiate cardiopulmonary resuscitation.
c. Administer analgesia and slow the test.
d. Stop the test and monitor the client closely.
d.
Patient may experience myocardial ischemia during stress test. There will be a doctor, a nurse, resuscitation equipment and crash cart in the stress test room in case of myocardial ischemia occur.
The nurse is assessing the patient’s cardiovascular system. The patient asks the nurse why the nurse presses on the toenails. Which is the best reply by the nurse?
a. “I can see how quickly the blood returns to assess blood flow.”
b. “I can tell a lot about your breathing from pressing on your toes.”
c. “Pressing on your toenail gives me an ideal about your pain tolerance.”
d. “I can learn things about your blood coagulation by pressing on your toenail.”
a.
capillary refill is to assess the peripheral blood flow.
The nurse is assessing an older adult’s cardiovascular system. Which assessment finding indicates to the nurse that the patient is experiencing age-related changes to the conduction system? Select all that apply.
a. murmur
b. bradycardia
c. presence of an S4
d. exercise intolerance
e. point of maximum impulse displaced to the left.
b, d
Bradycardia is due to slow conductivity. Due to that it will decrease cardiac output which also cause exercise intolerance.
Age-related changes including murmur, development of S4, and displacement of the point of maximum impulse. However, they are not part of the conductivity system.
A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching?
a. “I’ll keep a log of each time my ICD discharges.”
b. “I can’t wait to get back to my football league.”
c. “I have an appointment for magnetic resonance imaging of my knee scheduled for next week.”
d. “I need to stay at least 10 inches away from the microwave.”
a
The client stating that he should keep a log of all ICD discharges indicates effective teaching. This log helps the client and physician identify activities that may cause the arrhythmias that make the ICD discharge. He should also record the events right before the discharge.
Clients with ICDs should avoid contact sports such as football. They must also avoid magnetic fields, which could permanently damage the ICD. Household appliances don’t interfere with the ICD.
The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment?
a. A new myocardial infarction client
b. A client with poor kidney perfusion
c. A client with third-degree heart block
d. A client with atrial arrhythmias
d
The nurse is correct to identify a client with atrial arrhythmias as a candidate for cardioversion. The goal of cardioversion is to restore the normal pacemaker of the heart, as well as, normal conduction.
A client with a myocardial infarction has tissue damage.
The client with poor perfusion has circulation problems.
The client with heart block has an impairment in the conduction system and may require a pacemaker.
Which of the following does the nurse recognize as the therapeutic goal of radiofrequency catheter ablation for a client with cardiac arrhythmias?
a. Reperfusion of ischemic heart tissue
b. Dilation of arterial blood vessels
c. Destruction of errant tissue
d. Stimulation of the impulse center
c
The therapeutic goal of radiofrequency catheter ablation is to destroy errant tissue, in hopes of allowing impulse conduction to travel over appropriate pathways.
The goal does not include dilation of blood vessels or reperfusion of heart tissue. There is no stimulation of the heart.
The licensed practical nurse is setting up the room for a client arriving at the emergency department with ventricular arrhythmias. The nurse is most correct to place which of the following in the room for treatment?
a. A suction machine
b. A defibrillator
c. Cardioversion equipment
d. An ECG machine
b
The nurse is most correct to place a defibrillator close to the client room if not in the room. The nurse realizes that clients with ventricular dysrhythmias are at a high risk for fatal heart dysrhythmia and death.
A suction machine is used to remove respiratory secretions.
Cardioversion is used in a planned setting for atrial dysrhythmias.
An ECG machine records tracings of the heart for diagnostic purposes. Most clients with history of cardiac disorders have an ECG completed.
A client with type 2 diabetes and persistent atrial fibrillation is prescribed atenolol. Which actions will the nurse take when providing the medication to the client? Select all that apply.
a. Monitor heart rate.
b. Assess blood pressure.
c. Track liver function studies.
d. Monitor blood glucose level.
e. Evaluate renal function studies.
a, b, d
Beta-blockers are classified as Class II antiarrhythmic medications. This classification of medication decreases automaticity and conduction to treat atrial arrhythmias, however, it has the potential for adverse effects such as bradycardia, therefore the heart rate should be monitored. Because it can cause hypotension, the blood pressure should be assessed. The medication also affects blood glucose level. Since the client has type 2 diabetes, the blood glucose level should be monitored.
This medication does not affect liver or renal function.
The nurse is analyzing the cardiac rhythm of a client with a pacemaker and notes the QRS complex is absent after pacer spike. The nurse knows that reading can be caused by which of the following factors?
a. Client noncompliance
b. Lead wire fracture
c. Pacer undersensing
d. Loss of pacing
c
A pacemaker is an electronic device that provides electrical stimuli to the heart muscle. Pacemakers are usually used when a client has a permanent or temporary slower-than-normal impulse formation, or a symptomatic AV or ventricular conduction disturbance. They may also be used to control some tachyarrhythmias that do not respond to medication. When analyzing the function of the pacemaker, a loss of capture is indicated by a QRS complex not following the pacer spike. This could be caused by lead dislodgment, lead wire fracture, catheter malposition, a depleted battery, or myocardial ischemia. A total absence of pacer spikes indicates a loss of pacing. Pacer spikes occurring at preset intervals indicates undersensing. Pacer spikes not occurring at present intervals indicates oversensing.
The nurse checks the synchronizer switch before using a defibrillator to terminate ventricular fibrillation for what important reason?
a. The delivered shock must be synchronized with the client’s QRS complex.
b. The defibrillator won’t deliver a shock if the synchronizer switch is turned on.
c. The defibrillator won’t deliver a shock if the synchronizer switch is turned off.
d. The shock must be synchronized with the client’s T wave.
b
The nurse needs to check the synchronizer switch to ensure the switch is turned off. The defibrillator won’t deliver a shock to the client in ventricular fibrillation if the synchronizer switch is turned on because the defibrillator needs to recognize a QRS complex when the switch is turned on.
The synchronizer switch should be turned on when attempting to terminate arrhythmias that contain QRS complexes, such as rapid atrial fibrillation that’s resistant to pharmacologic measures. A synchronized shock should occur with the QRS complex, not the T wave, to avoid inducing ventricular fibrillation and allow for a lower shock dose.
A client with frequent premature ventricular contractions is prescribed amiodarone. The nurse will withhold the medication until the completion of which diagnostic test?
a. Echocardiogram
b. CT scan of the chest
c. Pulmonary function
d. Cardiac catheterization
c
Amiodarone is categorized as a Class III antiarrhythmic medication. It prolongs repolarization and treats and prevents ventricular arrhythmias. Because an adverse effect of amiodarone is pulmonary toxicity, base pulmonary function tests should be completed before starting the medication.
An echocardiogram, CT scan of the chest, and cardiac catheterization do not need to be completed before starting amiodarone.
The staff educator is teaching a class in arrhythmias. What statement is correct for defibrillation?
a. It is a scheduled procedure 1 to 10 days in advance.
b. The client is sedated before the procedure.
c. It is used to eliminate ventricular arrhythmias.
d. It uses less electrical energy than cardioversion.
c
The only treatment for a life-threatening ventricular arrhythmia is immediate defibrillation, which has the exact same effect as cardioversion, except that defibrillation is used when there is no functional ventricular contraction. It is an emergency procedure performed during resuscitation. The client is not sedated but is unresponsive. Defibrillation uses more electrical energy (200 to 360 joules) than cardioversion.
A nurse is educating a client with coronary artery disease about nitroglycerin administration. The nurse tells the client that nitroglycerin has what actions? Select all that apply.
a. Reduces myocardial oxygen consumption
b. Decreases the urge to use tobacco
c. Dilates blood vessels
d. Decreases ischemia
e. Relieves pain
a. c. d. e
Nitroglycerin dilates blood vessels and reduces the amount of blood returning to the heart, which reduces the workload of the heart and myocardial oxygen consumption. As the dilated vessels allow more blood supply to the heart, ischemia and pain are reduced.
Nitroglycerin does not affect the urge to use tobacco.
The laboratory values for a client diagnosed with coronary artery disease (CAD) have just come back from the lab. The client’s low-density lipoprotein (LDL) level is 112 mg/dL. The nurse recognizes that this value is
a. below the optimal range.
b. above the optimal range.
c. within the optimal range.
d. extremely high.
b
If the fasting LDL level ranges from 100 mg/dL to 130 mg/dL, it is considered above the optimal range. The ideal is to decrease the LDL level below 100 mg/dL (< 70 mg/dL for very high-risk patients).
A nurse educator is conducting an inservice for nursing students about how tobacco use impacts coronary artery disease (CAD)? What are the primary ways that tobacco use impacts CAD? Select all that apply.
a. Decreases the supply of oxygen to the myocardium
b. Increases platelet adhesion
c. Raises the heart rate and blood pressure
d. Causes the coronary arteries to dilate
e. Increases the blood carbon monoxide level
a, b, c, e
Nicotinic acid in tobacco triggers the release of catecholamines (hormones that are released due to stress), which raise the heart rate and blood pressure and cause coronary arteries to constrict. This increases the risk of CAD and sudden cardiac death. Tobacco use also increases oxidation of low-density lipoprotein (good) cholesterol, which results in increased platelet adhesion and thrombus formation. Ischemia and reduced contractility can result in the increase in carbon monoxide levels and decreased oxygenation of the myocardium.
A nurse completed a client physical examination for an insurance company. The nurse determined the client has increased blood pressure, increased blood glucose, levels and obesity. What condition for coronary artery disease does the nurse consider next?
a. congestive heart failure
b. hypolipidemia
c. metabolic syndrome
d. diabetes mellitus
c
Metabolic syndrome includes three of six conditions that are recognized as major risk factors for CAD. Insulin resistance is part of the syndrome, but the patient may not yet have diabetes.
A client comes to the emergency department (ED) reporting precordial chest pain. In describing the pain, the client describes it as pressure with a sudden onset. What disease process would the nurse suspect in this client?
a. Coronary artery disease
b. Raynaud syndrome
c. Cardiogenic shock
d. Venous occlusive disease
a
The classic symptom of CAD is chest pain (angina) or discomfort during activity or stress. Such pain or discomfort typically is manifested as sudden pain or pressure that may be centered over the heart (precordial) or under the sternum (substernal).
Raynaud syndrome in the hands presents with symptoms of hands that are cold, blanched, and wet with perspiration.
Cardiogenic shock is a complication of an MI.
Venous occlusive disease occurs in the veins, not the arteries.
The nurse is caring for a client diagnosed with coronary artery disease (CAD). What condition most commonly results in CAD?
a. atherosclerosis
b. diabetes mellitus
c. myocardial infarction
d. renal failure
a
Atherosclerosis (plaque formation) is the leading cause of CAD.
Diabetes mellitus is a risk factor for CAD, but it isn’t the most common cause.
Myocardial infarction is a common result of CAD.
Renal failure doesn’t cause CAD, but the two conditions are related.
A patient with coronary artery disease (CAD) is having a cardiac catheterization. What indicator is present for the patient to have a coronary artery bypass graft (CABG)?
a. The patient has compromised left ventricular function.
b. The patient has had angina longer than 3 years.
c. The patient has at least a 70% occlusion of a major coronary artery.
d. The patient has an ejection fraction of 65%.
c
For a patient to be considered for CABG, the coronary arteries to be bypassed must have approximately a 70% occlusion (60% if in the left main coronary artery).
A client with known coronary artery disease reports intermittent chest pain, usually on exertion. When teaching the client about nitroglycerin administration, which instruction should the nurse provide?
a. “Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up.”
b. “Replace leftover sublingual nitroglycerin tablets every 9 months to make sure your pills are fresh.”
c. “A burning sensation after administration indicates that the nitroglycerin tablets are potent.”
d. “You may take a sublingual nitroglycerin tablet every 30 minutes, if needed. You may take as many as four doses.”
a
Nitroglycerin commonly causes orthostatic hypotension and dizziness. To minimize these problems, the nurse should teach the client to take safety precautions, such as changing to an upright position slowly, climbing up and down stairs carefully, and lying down at the first sign of dizziness.
To ensure the freshness of sublingual nitroglycerin, the client should replace tablets every 6 months, not every 9 months, and store them in a tightly closed container in a cool, dark place. Many brands of sublingual nitroglycerin no longer produce a burning sensation. The client should take a sublingual nitroglycerin tablet at the first sign of angina. He may repeat the dose every 5 minutes for up to three doses; if this intervention doesn’t bring relief, the client should seek immediate medical attention.
The nurse is explaining the cause of angina pain to a client. What will the nurse say most directly caused the pain?
a. incomplete blockage of a major coronary artery
b. a destroyed part of the heart muscle
c. complete closure of an artery
d. a lack of oxygen in the heart muscle cells
d
Angina pectoris refers to chest pain that is brought about by myocardial ischemia. It is the result of cardiac muscle cells being deprived of oxygen due to the progressive symptoms of coronary artery disease.
Artery blockage or closure leads to myocardial death.
The destroyed part of the heart (death of heart tissue) is a myocardial infarction.
A nurse is obtaining a history from a new client in the cardiovascular clinic. When investigating for childhood diseases and disorders associated with structural heart disease, which finding should the nurse consider significant?
a. Croup
b. Rheumatic fever
c. Severe staphylococcal infection
d. Medullary sponge kidney
b
Childhood diseases and disorders associated with structural heart disease include rheumatic fever and severe streptococcal (not staphylococcal) infections.
Croup — a severe upper airway inflammation and obstruction that typically strikes children ages 3 months to 3 years — may cause latent complications, such as ear infection and pneumonia. However, it doesn’t affect heart structures.
Likewise, medullary sponge kidney, characterized by dilation of the renal pyramids and formation of cavities, clefts, and cysts in the renal medulla, may eventually lead to hypertension but doesn’t damage heart structures.
A client hospitalized for 10 days with subacute infective endocarditis is afebrile and has no signs of heart damage. Discharge with outpatient antibiotic therapy for 2 to 6 weeks is anticipated. During discharge planning with the client, what is most important for the nurse to review?
a. Plan how needs will be met while the client continues on bed rest.
b. Teach the client to avoid crowds and exposure to upper respiratory infections.
c. Encourage use of diversional activities to relieve boredom and restlessness.
d. Assess the client’s home environment in terms of family assistance and adequacy.
d
Long-term IV antimicrobial therapy is often necessary. The nurse should assess the home environment to ensure successful management of long-term antibiotic therapy. Bed rest is not necessary for the patient without heart damage. The others are not the most important steps for a client undergoing outpatient antibiotic therapy.
The staff educator is presenting a workshop on valvular disorders. When discussing the pathophysiology of aortic regurgitation, the educator describes what consequence of this disorder ?
a. Cardiac tamponade
b. Left ventricular hypertrophy
c. Right-sided heart failure
d. Ventricular insufficiency
b
Aortic regurgitation eventually causes left ventricular hypertrophy. In aortic regurgitation, blood from the aorta returns to the left ventricle during diastole in addition to the blood normally delivered by the left atrium. The left ventricle dilates, trying to accommodate the increased volume of blood.
Aortic regurgitation does not cause cardiac tamponade, right-sided heart failure, or ventricular insufficiency.
The nurse is caring for a client with right ventricular hypertrophy and, consequently, decreased right ventricular function. What valvular disorder may have contributed to this client’s diagnosis?
a. Mitral valve regurgitation
b. Aortic stenosis
c. Aortic regurgitation
d. Mitral valve stenosis
d
Because no valve protects the pulmonary veins from the backward flow of blood from the atrium, the pulmonary circulation becomes congested. As a result, the right ventricle must contract against an abnormally high pulmonary arterial pressure and is subjected to excessive strain. Eventually, the right ventricle fails.
None of the other listed valvular disorders has this pathophysiological effect.
A patient is admitted with suspected cardiomyopathy. What diagnostic test will the nurse need to teach the client about for identification of this disease?
a. serial enzyme studies
b. cardiac catheterization
c. echocardiogram
d. phonocardiogram
c
The echocardiogram is one of the most helpful diagnostic tools for cardiomyopathy because the structure and function of the ventricles can be observed easily.
Cardiac catheterization will focus on coronary vessels.
The serial enzymes are done to detect heart muscle damage.
The phonocardiogram is helpful for valve function.
The diagnosis of aortic regurgitation (AR) is confirmed by which of the following?
a. Echocardiography
b. Cardiac catheterization
c. Exercise stress testing
d. Myocardial biopsy
a
Diagnosis is confirmed by echocardiography.
Cardiac catheterization is not necessary in most patients with AR.
Exercise stress testing will assess functional capacity and symptom response.
A myocardial biopsy may be performed to analyze myocardial tissue cells in patients with cardiomyopathy.
In which type of cardiomyopathy does the heart muscle actually increase in size and mass weight, especially along the septum?
a. Hypertrophic
b. Dilated
c. Restrictive
d. Arrhythmogenic right ventricular
a
Because of structural changes, hypertrophic cardiomyopathy had also been called idiopathic hypertrophic subaortic stenosis or asymmetric septal hypertrophy.
Restrictive cardiomyopathy is characterized by diastolic dysfunction caused by rigid ventricular walls that impair ventricular stretch and diastolic filling.
Arrhythmogenic right ventricular cardiomyopathy occurs when the myocardium of the right ventricle is progressively infiltrated and replaced by fibrous scar and adipose tissue.
A client comes into the emergency department reporting about chest pain that gets worse when taking deep breaths and lying down. After ruling out a myocardial infarction, a nurse would assess for which diagnosis?
a. Rheumatic fever
b. Pericarditis
c. Mitral valve stenosis
d. Cardiomyopathy
b
The primary symptom of pericarditis is pain, which is assessed by evaluating the client in various positions. The nurse tries to identify whether pain is influenced by respiratory movements while holding an inhaled breath or holding an exhaled breath; by flexing, extending, or rotating the spine, including the neck; by moving the shoulders and arms; by coughing; or by swallowing. Recognizing events that precipitate or intensify pain may help establish a diagnosis and differentiate pain of pericarditis from pain of myocardial infarction.
