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ANSWERS
- A client is scheduled for a cardiac catherization using a radiopaque dye. Which of the following assessments is most critical before the procedure? 1.Intake and output 2.Baseline peripheral pulse rates 3.Height and weight 4.Allergy to iodine or shellfish - correct answer 4. Allergy to iodine or shellfish This procedure requires an informed consent because it involves injection of a radiopaque dye into the blood vessel. The risk of allergic reaction and possible anaphylaxis is serious and must be assessed before the procedure.
- A client with no history of cardiovascular disease comes into the ambulatory clinic with flulike symptoms. The client suddenly complains of chest pain. Which of the following questions would best help a nurse to discriminate pain caused by a non-cardiac problem? 1."Have you ever had this pain before?" 2."Can you describe the pain to me?" 3."Does the pain get worse when you breathe in?" 4."Can you rate the pain on a scale of 1-10, with 10 being the worst?" - correct answer 3."Does the pain get worse when you breathe in?"
ANSWERS
Chest pain is assessed by using the standard pain assessment parameters. Options 1, 2, and 4 may or may not help discriminate the origin of pain. Pain of pleuropulmonary origin usually worsens on inspiration.
- A client with myocardial infarction has been transferred from a coronary care unit to a general medical unit with cardiac monitoring via telemetry. A nurse plans to allow for which of the following client activities? 1.Strict bed rest for 24 hours after transfer 2.Bathroom privileges and self-care activities 3.Unsupervised hallway ambulation with distances under 200 feet 4.Ad lib activities because the client is monitored. - correct answer 2. Bathroom privileges and self-care activities On transfer from the CCU, the client is allowed self-care activities and bathroom privileges. Supervised ambulation for brief distances are encouraged, with distances gradually increased (50, 100, 200 feet). A nurse notes 2+ bilateral edema in the lower extremities of a client with myocardial infarction who was admitted 2 days ago. The nurse would plan to do which of the following next? 1.Review the intake and output records for the last 2 days 2.Change the time of diuretic administration from morning to evening
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- A nurse is assessing the blood pressure of a client diagnosed with primary hypertension. The nurse ensures accurate measurement by avoiding which of the following? 1.Seating the client with arm bared, supported, and at heart level. 2.Measuring the blood pressure after the client has been seated quietly for 5 minutes. 3.Using a cuff with a rubber bladder that encircles at least 80% of the limb. 4.Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion. - correct answer 4.Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion BP should be taken with the client seated with the arm bared, positioned with support and at heart level. The client should sit with the legs on the floor, feet uncrossed, and not speak during the recording. The client should not have smoked tobacco or taken in caffeine in the 30 minutes preceding the measurement. The client should rest quietly for 5 minutes before the reading is taken. The cuff bladder should encircle at least 80% of the limb being measured. Gauges other than a mercury sphygmomanometer should be calibrated every 6 months to ensure accuracy
- IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available on the nursing unit?
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1.Vitamin K 2.Aminocaporic acid 3.Potassium chloride 4.Protamine sulfate - correct answer 4. Protamine sulfate The antidote to heparin is protamine sulfate and should be readily available for use if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for warfarin.
- A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin (Coumadin). The client's prothrombin time is 20 seconds, with a control of 11 seconds. The nurse assesses that this result is: 1.The same as the client's own baseline level 2.Lower than the needed therapeutic level 3.Within the therapeutic range 4.Higher than the therapeutic range - correct answer 3. Within the therapeutic range (11 x 1.5=16.5) The therapeutic range for prothrombin time is 1.5 to 2 times the control for clients at risk for thrombus. Based on the client's control value, the therapeutic range for this individual would be 16.5 to 22 seconds. Therefore the result is within therapeutic range
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1.Administer the morphine 2.Obtain a 12-lead ECG 3.Obtain the lab work 4.Order the chest x-ray - correct answer 1.Administer the morphine Although obtaining the ECG, chest x-ray, and blood work are all important, the nurse's priority action would be to relieve the crushing chest pain.
- When administered a thrombolytic drug to the client experiencing an MI, the nurse explains to him that the purpose of this drug is to: 1.Help keep him well hydrated 2.Dissolve clots he may have 3.Prevent kidney failure 4.Treat potential cardiac arrhythmias. - correct answer 2. Dissolve clots he may have Thrombolytic drugs are administered within the first 6 hours after onset of a MI to lyse clots and reduce the extent of myocardial damage.
- When interpreting an ECG, the nurse would keep in mind which of the following about the P wave? Select all that apply. 1.Reflects electrical impulse beginning at the SA node
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2.Indicated electrical impulse beginning at the AV node 3.Reflects atrial muscle depolarization 4.Identifies ventricular muscle depolarization 5.Has duration of normally 0.11 seconds or less. - correct answer 1,3, In a client who has had an ECG, the P wave represents the activation of the electrical impulse in the SA node, which is then transmitted to the AV node. In addition, the P wave represents atrial muscle depolarization, not ventricular depolarization. The normal duration of the P wave is 0.11 seconds or less in duration and 2.5 mm or more in height.
- A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and informs the nurse that his father died of a heart attack at 60 years of age. The client is presently complaining of indigestion. The nurse connects him to an ECG monitor and begins administering oxygen at 2 L/minute per NC. The nurse's next action would be to: 1.Call for the doctor 2.Start an intravenous line 3.Obtain a portable chest radiograph 4.Draw blood for laboratory studies - correct answer 2. .Start an intravenous line Advanced cardiac life support recommends that at least one or two intravenous lines be inserted in one or both of the antecubital spaces. Calling the physician, obtaining a portable chest radiograph, and
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4.Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II. - correct answer 1. Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranolol hydrochloride include reducing heart rate, decreasing myocardial contractility, and slowing conduction.
- The most important long-term goal for a client with hypertension would be to: 1.Learn how to avoid stress 2.Explore a job change or early retirement 3.Make a commitment to long-term therapy 4.Control high blood pressure - correct answer .3. Compliance is the most critical element of hypertensive therapy. In most cases, hypertensive clients require lifelong treatment and their hypertension cannot be managed successfully without drug therapy. Stress management and weight management are important components of hypertension therapy, but the priority goal is related to compliance.
- Hypertension is known as the silent killer. This phrase is associated with the fact that hypertension often goes undetected until symptoms of other system failures occur. This may occur in the form of: 1.Cerebrovascular accident
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2.Liver disease 3.Myocardial infarction 4.Pulmonary disease - correct answer 1. Hypertension is referred to as the silent killer for adults, because until the adult has significant damage to other systems, the hypertension may go undetected. CVA's can be related to long-term hypertension. Liver or pulmonary disease is generally not associated with hypertension. Myocardial infarction is generally related to coronary artery disease.
- During the previous few months, a 56-year-old woman felt brief twinges of chest pain while working in her garden and has had frequent episodes of indigestion. She comes to the hospital after experiencing severe anterior chest pain while raking leaves. Her evaluation confirms a diagnosis of stable angina pectoris. After stabilization and treatment, the client is discharged from the hospital. At her follow-up appointment, she is discouraged because she is experiencing pain with increasing frequency. She states that she is visiting an invalid friend twice a week and now cannot walk up the second flight of steps to the friend's apartment without pain. Which of the following measures that the nurse could suggest would most likely help the client deal with this problem? 1.Visit her friend earlier in the day. 2.Rest for at least an hour before climbing the stairs. 3.Take a nitroglycerin tablet before climbing the stairs - correct answer
- Take a nitroglycerin tablet before climbing the stairs.
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3.Bypass obstructed vessels 4.Assess the functional adequacy of the valves and heart muscle. - correct answer 2. Assess the extent of arterial blockage Cardiac catherization is done in clients with angina primarily to assess the extent and severity of the coronary artery blockage, A decision about medical management, angioplasty, or coronary artery bypass surgery will be based on the catherization results.
- As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3mg given sublingually. This drug's principle effects are produced by: 1.Antispasmotic effect on the pericardium 2.Causing an increased mycocardial oxygen demand 3.Vasodilation of peripheral vasculature 4.Improved conductivity in the myocardium - correct answer 3.Vasodilation of peripheral vasculature Nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen consumption and demand. Vasodilation in coronary arteries and collateral vessels may also increase blood flow to the ischemic areas of the heart. Nitroglycerin decreases myocardial oxygen demand. Nitroglycerin does not have an effect on pericardial spasticity or conductivity in the myocardium.
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- The nurse teaches the client with angina about the common expected side effects of nitroglycerin, including: 1.Headache 2.High blood pressure 3.Shortness of breath 4.Stomach cramps - correct answer 1.Headache Because of the widespread vasodilating effects, nitroglycerin often produces such side effects as headache, hypotension, and dizziness. The client should lie or shit down to avoid fainting. Nitro does not cause shortness of breath or stomach cramps.
- Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct the client to use the drug when chest pain occurs? 1.Take one tablet every 2 to 5 minutes until the pain stops. 2.Take one tablet and rest for 10 minutes. Call the physician if pain persists after 10 minutes. 3.Take one tablet, then an additional tablet every 5 minutes for a total of 3 tablets. Call the physician if pain persists after three tablets. 4.Take one tablet. If pain persists after 5 minutes, take two tablets. If pain still persists 5 minutes later, call the physician. - correct answer 3. Take one tablet, then an additional tablet every 5 minutes for a total of 3 tablets. Call the physician if pain persists after three tablets.
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3.During expiration 4.During systole - correct answer 2.During diastolic Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow to coronary arteries is supplied during diastole. Breathing patterns are irrelevant to blood flow.
- Prolonged occlusion of the right coronary artery produces an infarction in which of the following areas of the heart? 1.Anterior 2.Apical 3.Inferior 4.Lateral - correct answer 3. Inferior The right coronary artery supplies the right ventricle, or the inferior portion of the heart. Therefore, prolonged occlusion could produce an infarction in that area. The right coronary artery doesn't supply the anterior portion (left ventricle), lateral portion (some of the left ventricle and the left atrium), or the apical portion (left ventricle) of the heart.
- A murmur is heard at the second left intercostal space along the left sternal border. Which valve is this? 1.Aortic
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2.Mitral 3.Pulmonic 4.Tricupsid - correct answer 3. Pulmonic Abnormalities of the pulmonic valve are auscultated at the second left intercostal space along the left sternal border. Aortic valve abnormalities are heard at the second intercostal space, to the right of the sternum. Mitral valve abnormalities are heard at the fifth intercostal space in the midclavicular line. Tricupsid valve abnormalities are heard at the 3rd and 4th intercostal spaces along the sternal border.
- Which of the following blood tests is most indicative of cardiac damage? 1.Lactate dehydrogenase 2.Complete blood count (CBC) 3.Troponin I 4.Creatine kinase (CK) - correct answer 3. Troponin I Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin levels aren't detectable in people without cardiac injury.
ANSWERS
The pain of angina usually ranges from a vague feeling of tightness to heavy, intense pain. Pain impulses originate in the most visceral muscles and may move to such areas as the chest, neck, and arms.
- Which of the following parameters is the major determinate of diastolic blood pressure? 1.Baroreceptors 2.Cardiac output 3.Renal function 4.Vascular resistance - correct answer 4.Vascular resistance Vascular resistance is the impedance of blood flow by the arterioles that most predominantly affects the diastolic pressure. Cardiac output determines systolic blood pressure.
- Which of the following factors can cause blood pressure to drop to normal levels? 1.Kidneys' excretion of sodium only 2.Kidneys' retention of sodium and water 3.Kidneys' excretion of sodium and water 4.Kidneys' retention of sodium and excretion of water - correct answer
- Kidneys' excretion of sodium and water
ANSWERS
The kidneys respond to a rise in blood pressure by excreting sodium and excess water. This response ultimately affects systolic pressure by regulating blood volume.
- Baroreceptors in the carotid artery walls and aorta respond to which of the following conditions? 1.Changes in blood pressure 2.Changes in arterial oxygen tension 3.Changes in arterial carbon dioxide tension 4.Changes in heart rate - correct answer 1.Changes in blood pressure Baroreceptors located in the carotid arteries and aorta sense pulsatile pressure. Decreases in pulsatile pressure cause a reflex increase in heart rate. Chemoreceptors in the medulla are primarily stimulated by carbon dioxide. Peripheral chemoreceptors in the aorta and carotid arteries are primarily stimulated by oxygen.
- Which of the following terms describes the force against which the ventricle must expel blood? 1.Afterload 2.Cardiac output 3.Overload 4.Preload - correct answer 1. Afterload
