Cardiac Rhythm Disorders and Management, Exams of Nursing

Download Cardiac Rhythm Disorders and Management and more Exams Nursing in PDF only on Docsity! Saunders NCLEX Questions Cardio-Questions with Answers Latest Update 2024 The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 second, and QRS complexes measure 0.06 second. The overall heart rate is 64 beats/minute. Which would be a correct interpretation based on these characteristics? 1. Sinus bradycardia 2. Sick sinus syndrome 3. Normal sinus rhythm 4. First-degree heart block - Correct Answer 3 Normal sinus rhythm is defined as a regular rhythm, with an overall rate of 60 to 100 beats/minute. The PR and QRS measurements are normal, measuring 0.12 to 0.20 second and 0.04 to 0.10 second, respectively. A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiographic complexes on the screen. Which is the priority action of the nurse? 1. Call a code. 2. Call the health care provider. 3. Check the client's status and lead placement. 4. Press the recorder button on the electrocardiogram console. - Correct Answer 3 Sudden loss of electrocardiographic complexes indicates ventricular asystole or possibly electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention. The remaining options are secondary to client assessment. A client is having frequent premature ventricular contractions. The nurse should place priority on assessment of which item? 1. Sensation of palpitations 2. Causative factors, such as caffeine 3. Precipitating factors, such as infection 4. Blood pressure and oxygen saturation - Correct Answer 4 Premature ventricular contractions can cause hemodynamic compromise. Therefore, the priority is to monitor the blood pressure and oxygen saturation. The shortened ventricular An expected outcome of aortoiliac bypass graft surgery is warmth, redness, and edema in the surgical extremity because of increased blood flow. The remaining options are incorrect interpretations. The nurse is evaluating the condition of a client after pericardiocentesis performed to treat cardiac tamponade. Which observation would indicate that the procedure was unsuccessful? 1. Rising blood pressure 2. Clearly audible heart sounds 3. Client expressions of relief 4. Rising central venous pressure - Correct Answer 4 Following pericardiocentesis, a rise in blood pressure and a fall in central venous pressure are expected. The client usually expresses immediate relief. Heart sounds are no longer muffled or distant. A client with angina complains that the anginal pain is prolonged and severe and occurs at the same time each day, most often at rest in the absence of precipitating factors. How would the nurse best describe this type of anginal pain? 1. Stable angina 2. Variant angina 3. Unstable angina 4. Nonanginal pain - Correct Answer 2 Variant angina, or Prinzmetal's angina, is prolonged and severe and occurs at the same time each day, most often at rest. Stable angina is induced by exercise and relieved by rest or nitroglycerin tablets. Unstable angina occurs at lower levels of activity or at rest, is less predictable, and is often a precursor of myocardial infarction. The nurse is monitoring a client with acute pericarditis for signs of cardiac tamponade. Which assessment finding indicates the presence of this complication? 1. Flat neck veins 2. A pulse rate of 60 beats/min 3. Muffled or distant heart sounds 4. Wheezing on auscultation of the lungs - Correct Answer 3 Assessment findings associated with cardiac tamponade include tachycardia, distant or muffled heart sounds, jugular vein distention with clear lung sounds, and a falling blood pressure accompanied by pulsus paradoxus (a drop in inspiratory blood pressure greater than 10 mm Hg). Bradycardia is not a sign of cardiac tamponade. The home care nurse is providing instructions to a client with an arterial ischemic leg ulcer about home care management and self-care management. Which statement, if made by the client, indicates a need for further instruction? 1. "I need to be sure not to go barefoot around the house." 2. "If I cut my toenails, I need to be sure that I cut them straight across." 3. "It is all right to apply lanolin to my feet, but I shouldn't place it between my toes." 4. "I need to be sure that I elevate my leg above my heart level for at least an hour every day." - Correct Answer 4 Foot care instructions for the client with peripheral arterial disease are the same as those for a client with diabetes mellitus. The client with arterial disease, however, should avoid raising the legs above the level of the heart unless instructed to do so as part of an exercise program or if venous stasis is also present. The client statements in options 1, 2, and 3 are correct statements. The nurse in the medical unit is reviewing the laboratory test results for a client who has been transferred from the intensive care unit. The nurse notes that a cardiac troponin T level assay was performed while the client was in the intensive care unit. The nurse determines that this test was performed to assist in diagnosing which condition? 1. Heart failure 2. 3. Administer an opioid analgesic every 4 hours around the clock. 4. Apply cool packs to the affected leg for 20 minutes every 4 hours. - Correct Answer 1 Standard management for the client with DVT includes bed rest; limb elevation; relief of discomfort with warm, moist heat; and analgesics as needed. Ambulation is contraindicated because such activity can cause the thrombus to dislodge and travel to the lungs. Opioid analgesics are not required to relieve pain, and pain normally is relieved with acetaminophen (Tylenol). The nurse has provided dietary instructions to a client with coronary artery disease. Which statement by the client indicates an understanding of the dietary instructions? 1. "I'll need to become a strict vegetarian." 2. "I should use polyunsaturated oils in my diet." 3. "I need to substitute eggs and whole milk for meat." 4. "I should eliminate all cholesterol and fat from my diet." - Correct Answer 2 The client with coronary artery disease should avoid foods high in saturated fat and cholesterol such as eggs, whole milk, and red meat. These foods contribute to increases in low-density lipoproteins. The use of polyunsaturated oils is recommended to control hypercholesterolemia. It is not necessary to eliminate all cholesterol and fat from the diet. It is not necessary to become a strict vegetarian. A client is scheduled for a cardiac catheterization to diagnose the extent of coronary artery disease. The nurse places highest priority on telling the client to report which sensation during the procedure? 1. Chest pain 2. Urge to cough 3. Warm, flushed feeling 4. Pressure at the insertion site - Correct Answer 1 The client is taught to report chest pain or any unusual sensations immediately. The client also is told that he or she may be asked to cough or breathe deeply from time to time during the procedure. The client is informed that a warm, flushed feeling may accompany dye injection and is normal. Because a local anesthetic is used, the client is expected to feel pressure at the insertion site. A client with a first-degree heart block has an electrocardiogram (ECG) taken during an episode of chest pain. The nurse knows that which ECG finding would be an indication of first-degree heart block? 1. Presence of Q waves 2. Tall, peaked T waves 3. Prolonged PR interval 4. Widened QRS complex - Correct Answer 3 A prolonged PR interval indicates first-degree heart block. The development of Q waves indicates myocardial necrosis. Tall, peaked T waves may indicate hyperkalemia. A widened QRS complex indicates a delay in intraventricular conduction, such as bundle branch block. An ECG taken during a pain episode is intended to capture ischemic changes, which also include ST-segment elevation or depression. A client with no history of heart disease has experienced acute myocardial infarction and has been given thrombolytic therapy with tissue plasminogen activator. What assessment finding should the nurse identify as the most likely indicator that the client is experiencing complications of this therapy? 1. Tarry stools 2. Nausea and vomiting 3. Orange-colored urine 4. Decreased urine output - Correct Answer 1 Thrombolytic agents are used to dissolve existing thrombi, and the nurse should monitor the client for obvious or occult signs of bleeding. This includes assessment for obvious bleeding within the gastrointestinal (GI) tract, urinary system, and skin. It also includes A client is admitted to the hospital with a diagnosis of aortic regurgitation. The nurse plans care for the client, knowing that the failure of the aortic valve to close completely allows blood to flow retrograde through which structures? 1. Aorta to left ventricle 2. Left ventricle to left atrium 3. Right ventricle to right atrium 4. Pulmonary artery to right ventricle - Correct Answer 1 The aortic valve separates the aorta from the left ventricle. Options 2, 3, and 4 describe the mitral, tricuspid, and pulmonic valves, respectively. A hospitalized client is experiencing a decrease in blood pressure. The nurse plans care for the client, knowing that this change will have which primary effect on his or her heart? 1. Decreased heart rate 2. Increased contractility 3. Decreased myocardial blood flow 4. Increased resistance to electrical stimulation - Correct Answer 3 The primary effect of a decrease in blood pressure is reduced blood flow to the myocardium. This in turn decreases oxygenation of the cardiac tissue. Cardiac tissue is likely to become more excitable or irritable in the presence of hypoxia. Correspondingly, the heart rate is likely to increase, not decrease, in response to this change. The effects of tissue ischemia lead to decreased contractility over time. A hospitalized client's serum calcium level is 7.9 mg/dL. The nurse is immediately concerned and takes action, knowing that this level could ultimately lead to which complication? 1. Stroke 2. Cardiac arrest 3. High blood pressure 4. Urinary stone formation - Correct Answer 2 The normal calcium level is 8.6 to 10 mg/dL. A low calcium level could lead to severe ventricular dysrhythmias, prolonged QT interval, and ultimately cardiac arrest. Calcium is needed by the heart for contraction. Calcium ions move across cell membranes into cardiac cells during depolarization and move back during repolarization. Depolarization is responsible for cardiac contraction. Options 1 and 3 are unrelated to calcium levels. Elevated calcium levels can lead to urinary stone formation. The nurse would take action and contact the health care provider when a calcium level is abnormal. A nurse is reinforcing instructions to a hospitalized client with heart block about the fundamental concepts regarding the cardiac rhythm. The nurse explains to the client that the normal site in the heart responsible for initiating electrical impulses is which site? 1. Bundle of His 2. Purkinje fibers 3. Sinoatrial (SA) node 4. Atrioventricular (AV) node - Correct Answer 3 The SA node is responsible for initiating electrical impulses that are conducted through the heart. The impulse leaves the SA node and travels down through internodal and interatrial pathways to the AV node. From there, impulses travel through the bundle of His to the right and left bundle branches and then to the Purkinje fibers. This group of specialized cardiac cells is referred to as the cardiac conduction system. The ability of this specialized tissue to generate its own impulses is called automaticity. A nursing instructor asks a nursing student to describe the structure and function of the coronary arteries. Which response by the student indicates a need for further research on the anatomy and physiology of the heart? 1. "The coronary arteries branch from the aorta." 2. "The coronary arteries supply the heart muscle with blood." 3. The heart, and when stimulated cause an increase in heart rate, atrioventricular (AV) node conduction, and contractility 4. Several tissues, and when stimulated cause contraction of smooth muscle, inhibition of lipolysis, and promotion of platelet aggregation - Correct Answer 1 Found in the peripheral arteries and veins, α1-adrenergic receptors cause a powerful vasoconstriction when stimulated. Options 2, 3, and 4 describe β1-, β2-, and α2- adrenergic receptors, respectively. A nurse who is auscultating a 56-year-old client's apical heart rate before administering digoxin (Lanoxin) notes that the heart rate is 52 beats/min. The nurse should make which interpretation about this information? 1. Normal, because of the client's age 2. Abnormal, requiring further assessment 3. Normal, as a result of the effects of digoxin 4. Normal, because this is the reason the client is receiving digoxin - Correct Answer 2 The normal heart rate is 60 to 100 beats/min in an adult. On auscultating a heart rate that is less than 60 beats/min, the nurse would not administer the digoxin and would report the finding to the health care provider. Digoxin increases the strength and contraction of the heart; it is not used to treat low heart rates. If a low heart rate is noted in a client taking digoxin, the medication is withheld and the health care provider is notified. Options 1, 3, and 4 are incorrect interpretations because the heart rate of 52 beats/min is not normal. A client who is beginning an exercise program asks the nurse why his heart "feels like it's pounding" when he is exercising vigorously. In formulating a response, the nurse understands that this effect occurs because of the client's primary need for which increased cardiac response? 1. Pulse rate 2. Cardiac index 3. Cardiac output 4. Stroke volume - Correct Answer 3 The client's symptoms are the direct result of the body's attempt to meet the metabolic demands generated during exercise. An adequate cardiac output is needed to maintain perfusion to the vital organs of the body. With exercise, these demands increase, and the heart must beat faster (increased heart rate) and harder (increased stroke volume) to meet them. Cardiac index is an artificial number used to determine the adequacy of the cardiac output for a given individual. It is calculated by adjusting the cardiac output for body surface area. A nurse is listening to a cardiologist explain the results of a cardiac catheterization to a client and family. The health care provider (HCP) tells the client that a blockage is present in the large blood vessel that supplies the anterior wall of the left ventricle. The nurse determines that the HCP is referring to which arteries? 1. Circumflex coronary artery 2. Right coronary artery (RCA) 3. Posterior descending coronary artery (PDA) 4. Left anterior descending coronary artery (LAD) - Correct Answer 4 The LAD bifurcates from the left main coronary artery to supply the anterior wall of the left ventricle and a few other structures. The circumflex coronary artery bifurcates from the left coronary artery and supplies the left atrium and the lateral wall of the left ventricle. The RCA supplies the right side of the heart, including the right atrium and right ventricle. The PDA supplies the posterior wall of the heart. A client who has had a myocardial infarction asks the nurse why she should not bear down or strain to ensure having a bowel movement. The nurse's response incorporates the information that bearing down or straining would trigger which physical response? 1. Vagus nerve stimulation, causing a decrease in heart rate and cardiac contractility 2. Vagus nerve stimulation, causing an increase in heart rate and cardiac contractility 3. Sympathetic nerve stimulation, causing an increase in heart rate and cardiac contractility 4. changes in the rate of firing of the sinoatrial node, which may occur with vagal tone and with respiration. Cardiac output is not affected. The nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. No P waves or QRS complexes are seen; instead, the monitor screen shows an irregular wavy line. The nurse interprets that the client is experiencing which rhythm? 1. Sinus tachycardia 2. Ventricular fibrillation 3. Ventricular tachycardia 4. Premature ventricular contractions (PVCs) - Correct Answer 2 Ventricular fibrillation is characterized by the absence of P waves and QRS complexes. The rhythm is instantly recognizable by the presence of coarse or fine fibrillatory waves on the cardiac monitoring screen. Sinus tachycardia has a recognizable P wave and QRS. Ventricular tachycardia is a regular pattern of wide QRS complexes. PVCs appear as irregular beats within a rhythm. Each of the incorrect options has a recognizable complex that appears on the monitoring screen. A client with myocardial infarction is experiencing new, multiform premature ventricular contractions (PVCs). Knowing that the client is allergic to lidocaine hydrochloride, the nurse plans to have which medication available for immediate use? 1. Procainamide 2. Digoxin (Lanoxin) 3. Verapamil (Calan SR) 4. Metoprolol (Lopressor) - Correct Answer 1 Procainamide is an antidysrhythmic that may be used to treat ventricular dysrhythmias in clients who are allergic to lidocaine. Digoxin is a cardiac glycoside; verapamil is a calcium- channel blocking agent; metoprolol is a β-adrenergic blocking agent. A client has received antidysrhythmic therapy for the treatment of premature ventricular contractions (PVCs). The nurse evaluates this therapy as most effective if the client's PVCs continued to exhibit which finding? 1. Occur in pairs 2. Appear to be multifocal 3. Fall on the second half of the T wave 4. Decrease to a frequency of less than 6 per minute - Correct Answer 4 PVCs are considered dangerous when they are frequent (more than 6 per minute), occur in pairs or couplets, are multifocal (multiform), or fall on the T wave. In each of these instances, the client's cardiac rhythm is likely to degenerate into ventricular tachycardia or ventricular fibrillation, both of which are potentially deadly dysrhythmias. The nurse is assessing the client's condition after cardioversion. Which observation should be of highest priority to the nurse? 1. Blood pressure 2. Status of airway 3. Oxygen flow rate 4. Level of consciousness - Correct Answer 2 Nursing responsibilities after cardioversion include maintenance of a patent airway, oxygen administration, assessment of vital signs and level of consciousness, and dysrhythmia detection. Airway, however, is always the highest priority. A client with a complete heart block has had a permanent demand ventricular pacemaker inserted. The nurse assesses for proper pacemaker function by examining the electrocardiogram (ECG) strip for the presence of pacemaker spikes at what point? 1. Before each P wave 2. Just after each P wave 3. Just after each T wave "I need to count my pulse every day." 2. "I have to do deep breathing exercises every 2 hours." 3. "I threw away my straight razor and bought an electric razor." 4. "I have to go to the bathroom frequently because of my medication." - Correct Answer 3 Prosthetic valves require long-term anticoagulation to prevent clots from forming on the "foreign" tissue implanted in the client's body. Anticoagulation therapy requires clients to avoid any trauma or potential means of causing bleeding, such as the use of straight razors. Counting pulse, deep breathing exercises, and going to the bathroom frequently are not specifically related to postoperative care after prosthetic valve replacement. The nurse is planning to teach a client with peripheral arterial disease about measures to limit disease progression. Which items should the nurse include on a list of suggestions for the client? Select all that apply. 1. Soak the feet in hot water daily. 2. Be careful not to injure the legs or feet. 3. Use a heating pad on the legs to aid vasodilation. 4. Walk each day to increase circulation to the legs. 5. Cut down on the amount of fats consumed in the diet. - Correct Answer 2, 4, 5 Long-term management of peripheral arterial disease consists of measures that increase peripheral circulation (exercise), promote vasodilation (warmth), relieve pain, and maintain tissue integrity (foot care and nutrition). Soaking the feet in hot water and application of a heating pad to the extremity is contraindicated. The affected extremity may have decreased sensitivity and is at risk for burns. Also, the affected tissue does not obtain adequate circulation at rest. Direct application of heat raises oxygen and nutritional requirements of the tissue even further. The home health nurse visits a client recovering from cardiogenic shock secondary to an anterior myocardial infarction and provides home care instructions to the client. Which statement by the client indicates an understanding of these home care measures? 1. "I exercise every day after breakfast." 2. "I've gained 8 pounds since discharge." 3. "I take an antacid when I experience epigastric pain." 4. "I have planned periods of rest at 10:00 am and 3:00 pm daily." - Correct Answer 4 The client recovering from cardiogenic shock secondary to a myocardial infarction will require a progressive rehabilitation related to physical activity. The heart requires several months to heal from an uncomplicated myocardial infarction. The complication of cardiogenic shock increases the recovery period for healing. Paced activities with planned rest periods will decrease the chance of experiencing angina or delayed healing. It is best to allow the meal to settle prior to activity in order to improve circulation to the heart during exercise. Epigastric pain or a weight gain of 8 pounds is significant and should be reported to the health care provider, at which point follow-up should occur. The nurse notes that a client's cardiac rhythm shows absent P waves and no PR interval. How should the nurse interpret this rhythm? 1. Bradycardia 2. Tachycardia 3. Atrial fibrillation 4. Normal sinus rhythm (NSR) - Correct Answer 3 In atrial fibrillation, the P waves may be absent. There is no PR interval, and the QRS duration usually is normal and constant. Bradycardia is a slowed heart rate, and tachycardia is a fast heart rate. In NSR a P wave precedes each QRS complex, the rhythm is essentially regular, the PR interval is 0.12 to 0.20 seconds in duration, and the QRS interval is 0.06 to 0.10 seconds in duration. The postmyocardial infarction client is scheduled for a technetium 99m ventriculography (multigated acquisition [MUGA] scan). The nurse ensures that which item is in place before the procedure? 1. A Foley catheter 2. Signed informed consent 4. The client has received an intravenous dose of a conscious sedation medication. - Correct Answer 1 During the procedure, any oxygen is removed temporarily because oxygen supports combustion, and a fire could result from electrical arcing. Digoxin may be withheld for up to 48 hours before cardioversion because it increases ventricular irritability and may cause ventricular dysrhythmias after the countershock. The defibrillator is switched to synchronizer mode to time the delivery of the electrical impulse to coincide with the QRS and avoid the T wave, which could cause ventricular fibrillation. Energy level typically is set at 50 to 100 J. The client typically receives a dose of an intravenous sedative or antianxiety agent. The nurse is assisting in the care of a client scheduled for cardioversion. The nurse plans to set the defibrillator to which starting energy range level, depending on the specific health care provider (HCP) prescription? 1. 50 to 100 joules 2. 150 to 300 joules 3. 300 to 350 joules 4. 350 to 400 joules - Correct Answer 1 For cardioversion procedures, the defibrillator is charged to the energy level prescribed by the HCP. Countershock usually is started at 50 to 100 joules. Options 2, 3, and 4 are incorrect. A client has developed uncontrolled atrial fibrillation with a ventricular rate of 150 beats/min. What manifestation should the nurse observe for when performing the client's focused assessment? 1. Flat neck veins 2. Nausea and vomiting 3. Hypotension and dizziness 4. Clubbed fingertips and headache - Correct Answer 3 The client with uncontrolled atrial fibrillation with a ventricular rate greater than 100 beats/min is at risk for low cardiac output due to loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins. The nurse has provided self-care activity instructions to a client after insertion of an automatic internal cardioverter-defibrillator (AICD). The nurse determines that further instruction is needed if the client makes which statement? 1. "I can perform activities such as swimming, driving, or operating heavy equipment as I need to." 2. "I need to avoid doing anything that could involve rough contact with the AICD insertion site." 3. "I should try to avoid doing strenuous things that would make my heart rate go up to or above the rate cutoff on the AICD." 4. "I should keep away from electromagnetic sources such as transformers, large electrical generators, metal detectors, and I shouldn't lean over running motors." - Correct Answer 1 Post discharge instructions typically include avoiding tight clothing or belts over AICD insertion sites; rough contact with the AICD insertion site; and electromagnetic fields such as with electrical transformers, radio/TV/radar transmitters, metal detectors, and running motors of cars or boats. Clients also must alert health care providers (HCP) or dentists to the presence of the device because certain procedures such as diathermy, electrocautery, and magnetic resonance imaging may need to be avoided to prevent device malfunction. Clients should follow the specific advice of a HCP regarding activities that are potentially hazardous to self or others, such as swimming, driving, or operating heavy equipment. A client with a history of hypertension has been prescribed triamterene (Dyrenium). The nurse determines that the client understands the effect of this medication on the diet if the client states to avoid which fruit? 1. Apples 2. Pears 3. Bananas 4. Cranberries - Correct Answer 3 A nurse is assessing a client with an abdominal aortic aneurysm. Which assessment finding by the nurse is most likely unrelated to the aneurysm? 1. Pulsatile abdominal mass 2. Hyperactive bowel sounds in the area 3. Systolic bruit over the area of the mass 4. Subjective sensation of "heart beating" in the abdomen - Correct Answer 2 Hyperactive bowel sounds are not related specifically to an abdominal aortic aneurysm. Not all clients with abdominal aortic aneurysm exhibit symptoms. Those who do may describe a feeling of the "heart beating" in the abdomen when supine or being able to feel the mass throbbing. A pulsatile mass may be palpated in the middle and upper abdomen. A systolic bruit may be auscultated over the mass. A nurse is providing postoperative care for a client who had a percutaneous insertion of an inferior vena cava filter and was on heparin therapy before surgery. The nurse should be most concerned about monitoring for which potential complications? 1. Bleeding and infection 2. Thrombosis and infection 3. Bleeding and wound dehiscence 4. Wound dehiscence and evisceration - Correct Answer 1 After inferior vena cava filter insertion, the nurse inspects the surgical site for bleeding and signs and symptoms of infection. Heparin therapy also predisposes the client to bleeding. Thrombosis is unlikely because the client is on heparin therapy. Wound dehiscence and evisceration are not concerns because no abdominal incision is made. A client with angina has a 12-lead electrocardiogram taken during an episode of chest pain. The nurse should examine the tracing for which electrocardiographic (ECG) change caused by myocardial ischemia? 1. Tall, peaked T waves 2. Prolonged PR interval 3. Widened QRS complex 4. ST segment elevation or depression - Correct Answer 4 An electrocardiogram taken during a chest pain episode captures ischemic changes, which include ST segment elevation or depression. Tall, peaked T waves may indicate hyperkalemia. A prolonged PR interval indicates first-degree heart block. A widened QRS complex indicates delay in intraventricular conduction, such as a bundle branch block. A client with rapid-rate atrial fibrillation asks a nurse why the health care provider is going to perform carotid sinus massage. Which is a correct explanation? 1. The vagus nerve slows the heart rate. 2. The diaphragmatic nerve slows the heart rate. 3. The diaphragmatic nerve overdrives the rhythm. 4. The vagus nerve increases the heart rate, overdriving the rhythm. - Correct Answer 1 Carotid sinus massage is one maneuver used for vagal stimulation to decrease a rapid heart rate and possibly terminate a tachydysrhythmia. Others include inducing the gag reflex and asking the client to strain or bear down. Medication therapy is often needed as an adjunct to keep the rate down or maintain the normal rhythm. The remaining options 2, 3, and 4 are incorrect descriptions of this procedure. A nurse assesses the sternotomy incision of a client on the third day after cardiac surgery. The incision shows some slight puffiness along the edges and is non-reddened, with no apparent drainage. The client's temperature is 99° F orally. The white blood cell count is 7500 cells/mm3. How should the nurse interpret these findings? 1. Incision is slightly edematous but shows no active signs of infection. 2. Incision shows early signs of infection, although the temperature is nearly normal. 4. Fifth intercostal space left midclavicular line - Correct Answer 2 The correct location for the V1 electrode is the fourth intercostal space right sternal border. Therefore, options 1, 3, and 4 are incorrect. A chaotic small, irregular, disorganized cardiac pattern suddenly appears on a client's cardiac monitor. Which is the nurse's first action? 1. Check the blood pressure. 2. Call the health care provider. 3. Check the client and the chest leads. 4. Initiate cardiopulmonary resuscitation (CPR). - Correct Answer 3 This type of pattern on the cardiac monitor indicates either ventricular fibrillation or lead displacement. The first action of the nurse is always to check the client and the chest leads. If the client is nonresponsive and the leads are not the problem, then option 4 would be the next choice, along with contacting the health care provider. A client's electrocardiogram shows that the atrial and ventricular rhythms are irregular and there are no discernible P waves. The nurse recognizes that this pattern is associated with which condition? 1. Atrial flutter 2. Atrial fibrillation 3. Third-degree AV block 4. First-degree atrioventricular (AV) block - Correct Answer 2 With atrial fibrillation, the atrial and ventricular rhythms are irregular and there are usually no discernible P waves. In atrial flutter, the QRS complexes may be either regular or irregular, and the P waves occur as flutter waves. A client in third-degree AV block (also known as complete heart block) has regular atrial and ventricular rhythms, but there is no connection between the P waves and the QRS complexes. In other words, the PR interval is variable and the QRS complexes are normal or widened, with no relationship with the P waves. With first-degree AV block the PR interval is longer than normal, and there is a connection between the occurrence of P waves and that of QRS complexes. A nurse reading the operative record of a client who had cardiac surgery notes that the client's cardiac output immediately after surgery was 3.2 L/min. Evaluation of the cardiac output results leads the nurse to make which conclusion? 1. The cardiac output is above the normal range. 2. The cardiac output is below the normal range. 3. The cardiac output is in the low-normal range. 4. The cardiac output is in the high-normal range. - Correct Answer 2 The normal cardiac output for the adult can range from 4 to 7 L/min. Therefore a cardiac output of 3.2 L/min is below normal range. A nurse is auscultating a 56 year old adult client's apical heart rate before giving digoxin (Lanoxin) and notes that the heart rate is 48 beats/minute. Which action should the nurse take? 1. Withhold the digoxin, and reevaluate the heart rate in 4 hours. 2. Administer half the prescribed dose to avoid a further decrease in heart rate. 3. Withhold the digoxin; assess for signs of decreased cardiac output and digoxin toxicity. 4. Administer the digoxin. The heart rate would be considered normal because of the client's age. - Correct Answer 3 The normal heart rate is 60 to 100 beats/min in an adult. If the nurse notes a heart rate that is less than 60 beats/min, the nurse would not administer the digoxin and would further evaluate the client for signs and symptoms of digoxin toxicity. When clients are bradycardic, they may have symptoms of decreased cardiac output so this would also be assessed. A nurse identifies that a client is having occasional premature ventricular contractions (PVCs) on the cardiac monitor. The nurse reviews the client's laboratory results and determines that which result would be consistent with the observation? 1. Flat neck veins 2. Nausea and vomiting 3. Hypotension and dizziness 4. Hypertension and headache - Correct Answer 3 The client with uncontrolled atrial fibrillation with a ventricular rate more than 100 beats/minute is at risk for low cardiac output because of loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins. The nurse is watching the cardiac monitor, and a client's rhythm suddenly changes. There are no P waves; instead, there are fibrillatory waves before each QRS complex. How should the nurse correctly interpret the client's heart rhythm? 1. Atrial fibrillation 2. Sinus tachycardia 3. Ventricular fibrillation 4. Ventricular tachycardia - Correct Answer 1 Atrial fibrillation is characterized by a loss of P waves and fibrillatory waves before each QRS complex. The atria quiver, which can lead to thrombus formation. The nurse is assisting to defibrillate a client in ventricular fibrillation. After placing the paddles on the client's chest and before discharging them, which intervention should be done? 1. Ensure that the client has been intubated. 2. Set the defibrillator to the "synchronize" mode. 3. Administer an amiodarone bolus intravenously. 4. Confirm that the rhythm is actually ventricular fibrillation. - Correct Answer 4 Until the defibrillator is attached and charged, the client is resuscitated by using cardiopulmonary resuscitation. Once the defibrillator has been attached, the electrocardiogram is checked to verify that the rhythm is ventricular fibrillation or pulseless ventricular tachycardia. Leads also are checked for any loose connections. A nitroglycerin patch, if present, is removed. The client does not have to be intubated to be defibrillated. The machine is not set to the synchronous mode because there is no underlying rhythm with which to synchronize. Amiodarone may be given subsequently but is not required before defibrillation. A client in ventricular fibrillation is about to be defibrillated. A nurse knows that to convert this rhythm effectively, the monophasic defibrillator machine should be set at which energy level (in joules, J) for the first delivery? 1. 50 J 2. 120 J 3. 200 J 4. 360 J - Correct Answer 4 The energy level used for all defibrillation attempts with a monophasic defibrillator is 360 joules. The nurse would evaluate that defibrillation of a client was most successful if which observation was made? 1. Arousable, sinus rhythm, BP 116/72 mm Hg 2. Nonarousable, sinus rhythm, BP 88/60 mm Hg 3. Arousable, marked bradycardia, BP 86/54 mm Hg 4. Nonarousable, supraventricular tachycardia, BP 122/60 mm Hg - Correct Answer 1 4. Protamine sulfate - Correct Answer 2 Phentolamine is an α-adrenergic blocking agent that prevents dermal necrosis and sloughing after infiltration of norepinephrine or dopamine. Vitamin K is the antidote for warfarin (Coumadin). Atropine sulfate is the antidote for cholinergic crisis. Protamine sulfate is the antidote for heparin. A client admitted with hypertensive crisis has an intravenous (IV) infusion of 1000 mL of normal saline with 20 mEq of potassium chloride added. A prescription is written to administer sodium nitroprusside by continuous IV infusion. The nurse should plan to do which to administer this medication? 1. Monitor the blood pressure every 15 minutes during administration. 2. Protect the sodium nitroprusside from light with an opaque material. 3. Check the solution for a faint brown coloration and discard it if this is noticed. 4. Piggyback the sodium nitroprusside into the IV line containing the potassium chloride. - Correct Answer 2 Sodium nitroprusside can be degraded by light and should be protected with an opaque material. It is dispensed in powdered form and must be dissolved and diluted for the IV solution. A fresh solution may have a faint brown coloration, but solutions that are deeply colored, such as blue-green or dark red, should be discarded. No other medication should be mixed with the infusion solution. During the infusion, the blood pressure should be monitored continuously either through an arterial line or with an electronic monitoring device. A left atrial catheter is inserted into a client during cardiac surgery. The nurse is monitoring the left atrial pressure (LAP) and documents the following pressure. Which readings are within normal limits (WNL) for the client? Select all that apply. 1. 6 mm Hg 2. 8 mm Hg 3. 15 mm Hg 4. 25 mm Hg 5. 32 mm Hg - Correct Answer 1, 2 The normal LAP is 1 to 10 mm Hg; therefore, options 1 and 2 are correct. Because the left atrium does not generate significant pressure during atrial contraction, the atrial pressure is recorded as an average (mean) pressure, rather than as a systolic or diastolic pressure. Options 3, 4, and 5 are incorrect and elevated pressures. The nurse is reviewing the medical record of a client transferred to the medical unit from the critical care unit. The nurse notes that the client received intra-aortic balloon pump (IABP) therapy while in the critical care unit. The nurse suspects that the client received this therapy for which condition? 1. Heart failure 2. Pulmonary edema 3. Cardiogenic shock 4. Aortic insufficiency - Correct Answer 3 IABP therapy most often is used in the treatment of cardiogenic shock and is most effective if instituted early in the course of treatment. Use of the IABP is contraindicated in clients with aortic insufficiency and thoracic and abdominal aneurysms. This therapy is not used in the treatment of congestive heart failure or pulmonary edema. The nurse is documenting information in a client's chart when the electrocardiogram telemetry alarm sounds, and the nurse notes that the client is in ventricular tachycardia (VT). The nurse rushes to the client's bedside and should perform which assessment first? 1. Cardiac rate 2. Blood pressure 3. Respiratory rate 4. Responsiveness of the client - Correct Answer 4 Diltiazem hydrochloride is a calcium channel blocker used in the treatment of atrial flutter and fibrillation. It decreases myocardial contractility and workload, thereby decreasing the need for oxygen. A bolus of 0.25 mg/kg is given slowly over 2 minutes, and a continuous infusion of 5 to 10 mg/hour may be continued for up to 24 hours. A client being admitted to the coronary care unit from the emergency department has a stat prescription to receive a dose of procainamide. The nurse interprets that the client has which condition if this medication is needed? 1. Dyspnea 2. Bradycardia 3. Hypertension 4. Ventricular ectopy - Correct Answer 4 Procainamide is an antidysrhythmic medication used to treat ventricular dysrhythmias unresponsive to lidocaine. The other options are not indications for giving this medication. The nurse has a prescription to give amiodarone (Cordarone) intravenously to a client. During administration of this medication, the nurse should monitor which option as the priority? 1. Blood pressure 2. Cardiac rhythm 3. Skin color and dryness 4. Oxygen saturation level - Correct Answer 2 Amiodarone is an antidysrhythmic used to treat life-threatening ventricular dysrhythmias. The client requires continuous cardiac monitoring, with infusion of the medication by an intravenous pump. Although the other assessments are not incorrect, monitoring of cardiac rhythm is the priority nursing action. The nurse is caring for a client with a diagnosis of myocardial infarction (MI). The client is experiencing chest pain that is unrelieved by the administration of nitroglycerin. The nurse administers morphine sulfate to the client as prescribed by the health care provider. After administration of the morphine sulfate, the nurse plans to monitor which item(s) most closely? 1. Mental status 2. Urinary output 3. Respirations and blood pressure 4. Temperature and blood pressure - Correct Answer 3 Morphine sulfate is an opioid analgesic that may be administered to relieve pain in a client with MI. The nurse would monitor the client's respirations and blood pressure. Signs of morphine toxicity include respiratory depression and hypotension. Although monitoring mental status is a component of the nurse's assessment, it is not the priority after administration of morphine sulfate. Urinary output is unrelated to the administration of this medication. Monitoring the temperature also is not associated with the use of this medication. A client hospitalized with a diagnosis of myocardial infarction calls for the unit nurse because the client is experiencing chest pain. The nurse administers a sublingual nitroglycerin tablet as prescribed. The client, who is receiving oxygen by nasal cannula, reports that her chest pain is unrelieved by the nitroglycerin. Which is the next nursing action for this client? 1. Call the client's family. 2. Increase the flow rate of oxygen. 3. Contact the health care provider (HCP). 4. Administer another nitroglycerin tablet. - Correct Answer 4 For the hospitalized client, nitroglycerin tablets are administered one tablet every 5 minutes, for a total of three tablets per episode of chest pain, so long as the client maintains a systolic blood pressure of 100 mm Hg or higher. Increasing the flow rate of oxygen may be prescribed by the HCP but would not be the next nursing action. If three nitroglycerin tablets do not relieve the client's chest pain, the HCP needs to be notified. It is premature to call the client's family The home health nurse is visiting an older client whose family has gone out for the day. During the visit, the client experiences chest pain that is unrelieved by sublingual nitroglycerin tablets given by the nurse. Which action by the nurse would be appropriate at this time? The client who has experienced a myocardial infarction (MI) is recovering from cardiogenic shock. The nurse knows that which observation of the client's clinical condition is most favorable? 1. Urine output of 40 mL/hr 2. Heart rate of 110 beats/min 3. Frequent premature ventricular contractions 4. Central venous pressure (CVP) of 15 mm Hg - Correct Answer 1 Urine output of greater than 30 mL/hr indicates adequate perfusion to the kidneys, so the other organs are most likely equally perfused. Classic cardiovascular signs of cardiogenic shock include low blood pressure and tachycardia. Dysrhythmias commonly occur as a result of decreased oxygenation to the myocardium and are not a favorable sign. The CVP rises as the effects of the backward blood flow caused by the left ventricular failure became apparent. A client with heart failure has been started on intravenous medication therapy with inamrinone. The nurse determines which finding, if noted in the client, is an adverse effect of the medication? 1. Hypotension 2. Decreased weight 3. Absence of lung crackles 4. Reduced peripheral edema - Correct Answer 1 Inamrinone is an inotropic agent used to relieve the manifestations of heart failure. Therapeutic effects include a decrease in weight (fluid), lung crackles, dyspnea, and edema. Blood pressure should remain stable or increase (if the client is hypotensive). Hypotension is an adverse effect of the medication. A client in cardiogenic shock has a pulmonary artery catheter (Swan-Ganz type) placed. The nurse would interpret which cardiac output (CO) and pulmonary capillary wedge pressure (PCWP) readings as indicating that the client is most unstable? 1. CO 5 L/min, PCWP low 2. CO 3 L/min, PCWP low 3. CO 4 L/min, PCWP high 4. CO 3 L/min, PCWP high - Correct Answer 4 The normal cardiac output is 4 to 7 L/min. With cardiogenic shock, the CO falls below normal because of failure of the heart as a pump. The PCWP, however, rises because it is a reflection of the left ventricular end-diastolic pressure, which rises with pump failure. A client in cardiogenic shock had an intra-aortic balloon pump inserted 24 hours earlier via the left femoral approach. The nurse notes that the client's left foot is cool and mottled and the left pedal pulse is weak. Which action should the nurse take? 1. Call the health care provider immediately. 2. Re-evaluate the neurovascular status in 1 hour. 3. Increase the rate of intravenous nitroglycerin that is infusing. 4. Document these findings, which are expected because of the catheter size. - Correct Answer 1 The nursing interventions for the client with an intra-aortic balloon pump are the same as for any client who has had cardiovascular surgery. The peripheral circulation to the affected limb is monitored for signs of occlusion, such as coolness, mottling, pain, tingling, and decreased or absent distal pulse. Adverse changes are reported immediately. Options 2, 3, and 4 are incorrect. A nurse reading the operative record for a client who has undergone cardiac surgery notes that the client's cardiac output immediately after surgery was 3.6 L/min. The nurse determines that this measurement indicates which finding? 1. Above the normal range 2. In the high-normal range The ratio of compressions to ventilations is 30:2. 2. The carotid pulse is palpable with each compression. 3. Respirations are given at a rate of 10 breaths per minute. 4. The chest compressions are given at a depth of 1.5 to 2 inches. - Correct Answer 2 With effective compressions, carotid pulsations should be present. At its best, CPR produces only 30% of the normal cardiac output, so correct technique is vital. Assessment of the carotid pulse during CPR is the most accurate way to assess the effectiveness of CPR. Correct procedure for CPR in an adult includes a compression-to-ventilation ratio of 30:2. With adults, compressions are performed at a depth of 1.5 to 2 inches. The 30:2 compression-ventilation ratio yields an effective rate of 8 to 10 breaths per minute. The nurse is assessing a client hospitalized with acute pericarditis. The nurse monitors the client for cardiac tamponade, knowing that which signs are associated with this complication of pericarditis? Select all that apply. 1. Bradycardia 2. Pulsus paradoxus 3. Distant heart sounds 4. Falling blood pressure 5. Distended jugular veins - Correct Answer 2, 3, 4, 5 Assessment findings with cardiac tamponade include tachycardia, distant or muffled heart sounds, jugular vein distention, and a falling blood pressure (BP), accompanied by pulsus paradoxus (a drop in inspiratory BP by greater than 10 mm Hg). A client has frequent runs of ventricular tachycardia. The health care provider has prescribed an antidysrhythmic, flecainide (Tambocor). What is the best nursing action related to the effects of this medication? 1. Monitor the client's urinary output. 2. Assess the client for neurological changes. 3. Keep the call bell within the client's reach. 4. Monitor the client's vital signs and cardiac rhythm frequently. - Correct Answer 4 Flecainide is an antidysrhythmic medication that slows conduction and decreases excitability, conduction velocity, and automaticity. The nurse needs to monitor the client's vital signs for changes and cardiac rhythm for the development of a new or a worsening dysrhythmia. Options 1, 2, and 3 are components of standard care. A client in ventricular fibrillation is brought into the emergency department. The advanced cardiac life support (ACLS) nurse prepares to defibrillate by placing conductive gel pads on which part of the client's chest? 1. The upper and lower halves of the sternum 2. Parallel between the umbilicus and the right nipple 3. The right shoulder and the back of the left shoulder 4. To the right of the sternum below the clavicle and to the left of the precordium - Correct Answer 4 The ACLS nurse should place one gel pad to the right of the sternum just below the clavicle and the other gel pad to the left of the precordium. The nurse then places the electrode paddles over the pads. The remaining options describe incorrect positions. he nurse is providing care for a client with new onset of a atrial fibrillation dysrhythmia. The nurse anticipates which prescriptions from the health care provider? Select all that apply. 1. Oxygen therapy 2. An echocardiogram 3. An intravenous dose of metoprolol (Lopressor) 4. Hold the defibrillator paddles firmly against the chest. 2. Apply adhesive patch electrodes to the chest and move away from the client. 3. Connect standard electrocardiographic electrodes to a transtelephonic monitoring device. 4. Apply standard electrocardiographic monitoring leads to the client, and observe the rhythm. - Correct Answer 2 The nurse or rescuer puts two large adhesive patch electrodes on the client's chest in the usual defibrillator positions. The nurse stops cardiopulmonary resuscitation and requests that anyone near the client to move away and not touch the client. The defibrillator then analyzes the rhythm, which may take up to 30 seconds. The machine then indicates whether defibrillation is necessary. The nurse is told by a health care provider that a client in hypovolemic shock will require plasma expansion. The nurse anticipates receiving a prescription to transfuse which product? 1. Albumin 2. Platelets 3. Cryoprecipitate 4. Packed red blood cells - Correct Answer 1 Albumin may be used as a plasma expander. Platelets are used when the client's platelet count is low. Cryoprecipitate is useful in treating bleeding from hemophilia or disseminated intravascular coagulopathy because it is rich in clotting factors. Packed red blood cells replace erythrocytes and are not a plasma expander. A client experiencing cocaine toxicity is brought to the emergency department. The nurse should prepare to take which initial action? 1. Ensure a patent airway. 2. Administer naloxone (Narcan). 3. Establish an intravenous access. 4. Obtain a 12-lead electrocardiogram (ECG). - Correct Answer 1 Initial management when caring for a client with cocaine toxicity is to ensure a patent airway. Although options 2, 3, and 4 are components of care, airway is the priority. Which readings obtained from a client's pulmonary artery catheter suggest that the client is in left-sided heart failure? 1. Cardiac output of 5 L/min 2. Right atrial pressure of 9 mm Hg 3. Pulmonary capillary wedge pressure (PCWP) 20 mm Hg 4. Pulmonary artery systolic/diastolic pressures of 24/10 mm Hg - Correct Answer 3 Normal PCWP ranges from 8 to 15 mm Hg. A PCWP of 20 mm Hg is elevated and corresponds to volume overload of the left ventricle, such as occurs in heart failure. Options 1, 2, and 4 are normal values. Which should the nurse do when setting up an arterial line? 1. Tighten all tubing connections. 2. Use macrodrop intravenous tubing. 3. Level the transducer to the ventricle. 4. Raise the height of the normal saline infusion to prevent backup. - Correct Answer 1 Because the arterial vasculature is a high-pressure system, all tubing connections must be tight to avoid blood loss from loose connections. High-pressure tubing with a transducer is used (not macrodrip tubing). The transducer should be level to the atrium not the ventricle. Raising the height of the infusion is not sufficient to prevent backflow. A client is admitted to the hospital for an acute episode of angina pectoris. Which parameter is the priority for the nurse to monitor? An automatic external defibrillator (AED) interprets that the rhythm of a pulseless client is ventricular fibrillation. Which action should the nurse take next? 1. Administers rescue breathing during the defibrillation 2. Performs cardiopulmonary resuscitation (CPR) for 1 minute before defibrillating 3. Charges the machine and immediately pushes the discharge buttons on the console 4. Orders personnel away from the client, charges the machine, and depresses the discharge buttons - Correct Answer 4 If the AED advises to defibrillate, the rescuer orders all personnel away from the client, charges the machine, and pushes both of the discharge buttons on the console at the same time. The charge is delivered through the patch electrodes, so this method is known as "hands off" defibrillation, which is safer for the rescuer. The sequence of charges is similar to that of conventional defibrillation. A nurse overhears a health care provider (HCP) stating that a client who is in hypovolemic shock requires plasma expansion. Which blood product should the nurse anticipate that the HCP will write a prescription for? 1. Albumin 2. Platelets 3. Cryoprecipitate 4. Packed red blood cells - Correct Answer 1 Albumin may be used as a plasma expander in hypovolemia with or without shock. Platelets are used when the client's platelet count is low, typically below 20,000/mm3. Cryoprecipitate is useful in treating bleeding from hemophilia or disseminated intravascular coagulopathy because it is rich in clotting factors. Packed red blood cells replace erythrocytes and are not a plasma expander. A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hour. The nurse determines that the client is receiving the therapeutic effect based on which results? 1. Prothrombin time of 12.5 seconds 2. Activated partial thromboplastin time of 60 seconds 3. Activated partial thromboplastin time of 28 seconds 4. Activated partial thromboplastin time longer than 120 seconds - Correct Answer 2 Common laboratory ranges for activated partial thromboplastin time are 20 to 36 seconds. Because the activated partial thromboplastin time should be 1.5 to 2.5 times the normal value, the client's activated partial thromboplastin time would be considered therapeutic if it was 60 seconds. A client who is receiving digoxin (Lanoxin) daily has a serum potassium level of 3 mEq/L and is complaining of anorexia. The health care provider prescribes determination of the serum digoxin level to rule out digoxin toxicity. The nurse checks the results, knowing that which value is the therapeutic serum level (range) for digoxin? 1. 0.5 to 2 ng/mL 2. 1.2 to 2.8 ng/mL 3. 3.0 to 5.0 ng/mL 4. 3.5 to 5.5 ng/mL - Correct Answer 1 Therapeutic levels for digoxin range from 0.5 to 2 ng/mL. The ranges in the remaining options are incorrect. A client is being treated with procainamide for a cardiac dysrhythmia. Following intravenous administration of the medication, the client complains of dizziness. What intervention should the nurse take first? 1. Measure the heart rate on the rhythm strip. 2. Administer prescribed nitroglycerin tablets. 3. Obtain a 12-lead electrocardiogram immediately. Diarrhea 3. Irritability 4. Blurred vision 5. Nausea and vomiting - Correct Answer 2,4,5 Digoxin (Lanoxin) is a cardiac glycoside. The risk of toxicity can occur with the use of this medication. Toxicity can lead to life-threatening events and the nurse needs to monitor the client closely for signs of toxicity. Early signs of toxicity include gastrointestinal manifestations such as anorexia, nausea, vomiting, and diarrhea. Subsequent manifestations include headache; visual disturbances such as diplopia, blurred vision, yellow-green halos, and photophobia; drowsiness; fatigue; and weakness. Cardiac rhythm abnormalities can also occur. The nurse also monitors the digoxin level. Therapeutic levels for digoxin range from 0.5 to 2 ng/mL. Prior to administering a client's daily dose of digoxin, the nurse reviews the client's laboratory data and notes the following results: serum calcium, 9.8 mg/dL; serum magnesium, 1.2 mg/dL; serum potassium, 4.1 mEq/L; serum creatinine, 0.9 mg/dL. Which result should alert the nurse that the client is at risk for digoxin toxicity? 1. Serum calcium level 2. Serum potassium level 3. Serum creatinine level 4. Serum magnesium level - Correct Answer 4 An increased risk of toxicity exists in clients with hypercalcemia, hypokalemia, hypomagnesemia, hypothyroidism, and impaired renal function. The calcium, creatinine, and potassium levels are all within normal limits. The normal range for magnesium is 1.6 to 2.6 mg/dL and the results in the correct option are reflective of hypomagnesemia. The home care nurse has given instructions to a client who is beginning therapy with digoxin (Lanoxin). The nurse determines a need for further teaching of the instructions if the client makes which statement? 1. "If I miss a dose, I should just take two the next day." 2. "I shouldn't change brands without asking the health care provider first." 3. "I should call the health care provider if my daily pulse rate is under 60 or over 100." 4. "The pills should be kept in their original container so they don't get mixed up with my other medicines." - Correct Answer 1 Client teaching should include taking the dose exactly as prescribed each day. If the client misses a dose and more than 12 hours goes by, that dose should be omitted, and only the next scheduled dose should be taken; the client should not double-dose. The HCP should be consulted before changing brands because the bioavailability of another preparation of the medication may be different. A daily pulse check is necessary, and the client should know the parameters for which the health care provider (HCP) should be called. Clients are advised not to mix digoxin in pill boxes with other medications. The nurse is providing instructions to a client with chronic atrial fibrillation who is being started on quinidine sulfate. The nurse should plan to provide which instruction to the client? 1. Wear a Medic-Alert bracelet. 2. Take the medication only on an empty stomach. 3. Stop taking the prescribed digoxin (Lanoxin) when this medication is started. 4. Open the sustained-release capsules and mix with applesauce if the medication is difficult to swallow. - Correct Answer A health care provider (HCP) prescribes quinidine gluconate for a client. The nurse decides to withhold the medication and contact the HCP if which assessment finding is documented in the client's medical record? 1. Muscle weakness 2. History of asthma 3. Presence of infection 4. "I will take the dose at the same time each day." 3. "I will take the medication with food if my stomach becomes upset." 4. "I will stop taking the prescribed anticoagulant after starting this new medication." - Correct Answer 4 Medication-specific teaching points for quinidine sulfate include to take the medication exactly as prescribed, not to chew the tablets, to take with food if stomach upset occurs, to wear a medical identification (e.g., Medic-Alert) bracelet or tag, and to have periodic checks of heart rhythm and blood counts. The client should not stop taking a prescribed medication unless specifically prescribed by the health care provider. A client with cardiac disease has begun taking propranolol (Inderal LA), and the nurse provides information to the client about the medication. The nurse should tell the client to contact the health care provider (HCP) if which symptoms develop? 1. Insomnia and headache 2. Nausea and constipation 3. Night cough and dyspnea 4. Drowsiness and nightmares - Correct Answer 3 Propranolol is a β-adrenergic blocker that is used as an antihypertensive, antianginal, antidysrhythmic, and antimigraine medication. It may precipitate heart failure or myocardial infarction in clients with cardiac disease. Signs of heart failure include dyspnea (particularly on exertion or lying down), night cough, peripheral edema, and distended neck veins. If signs of heart failure occur, the HCP should be notified. Options 1, 2, and 4 identify side effects of this medication that do not warrant HCP notification if they occur. Hydrochlorothiazide (HydroDIURIL) has been prescribed for a client. The nurse contacts the health care provider to verify the prescription if which condition is noted in the assessment data? 1. Hypertension 2. Allergy to eggs 3. Nephrotic syndrome 4. Allergy to sulfonamides - Correct Answer 4 Hydrochlorothiazide is a diuretic and antihypertensive medication that is used to treat mild to moderate hypertension, edema associated with heart failure, and nephrotic syndrome. The medication is a sulfonamide derivative. A contraindication to the use of this medication is a history of hypersensitivity to sulfonamides. The conditions noted in options 1, 2, and 3 are not contraindications for the use of this medication. A client is seen in the clinic complaining of anorexia and nausea. The health care provider suspects that the client may be experiencing digoxin toxicity. While waiting for test results to become available, the nurse should assess the client for which sign or symptom that would support a diagnosis of digoxin toxicity? 1. Edema 2. Chest pain 3. Constipation 4. Photophobia - Correct Answer 4 The most common early manifestations of digoxin toxicity are gastrointestinal disturbances such as anorexia, nausea, and vomiting and neurological disturbances such as fatigue, headache, weakness, drowsiness, confusion, and nightmares. Visual disturbances such as photophobia, light flashes, halos around bright objects, and yellow or green color perception also may occur. The nurse is performing an assessment on a client with a diagnosis of chronic angina pectoris. The client is receiving sotalol (Betapace) orally daily. Which assessment finding indicates to the nurse that the client is experiencing a side/adverse effect related to the medication? 1. Dry mouth 2. Diaphoresis 3. Palpitations 4. Difficulty swallowing - Correct Answer 3 Persantine combined with warfarin sodium (Coumadin) is prescribed to protect the client's artificial heart valves. Persantine does not prevent strokes, heart attacks, or hypertension. A client in the postpartum care unit who is recovering from disseminated intravascular coagulopathy is to be discharged on low dosages of an anticoagulant medication. In developing home care instructions for this client, the nurse should include which priority safety instruction regarding this medication? 1. Avoid brushing the teeth. 2. Avoid taking acetylsalicylic acid (aspirin). 3. Avoid walking long distances and climbing stairs. 4. Avoid all activities because bruising injuries can occur. - Correct Answer 2 Aspirin can interact with the anticoagulant medication to increase clotting time beyond therapeutic ranges. Avoiding aspirin is a priority. The client does not need to avoid brushing the teeth; however, the client should be instructed to use a soft toothbrush. Walking and climbing stairs are acceptable activities. Not all activities need to be avoided. Levothyroxine (Synthroid) is prescribed for a client diagnosed with hypothyroidism. The nurse reviews the client's record and notes that the client is presently taking warfarin (Coumadin). The nurse contacts the health care provider (HCP), anticipating that the HCP will prescribe which medication? 1. A decreased dosage of warfarin 2. An increased dosage of warfarin 3. A decreased dosage of levothyroxine 4. An increased dosage of levothyroxine - Correct Answer 1 Levothyroxine (Synthroid) accelerates the degradation of vitamin K-dependent clotting factors. As a result, the effects of warfarin (Coumadin) are enhanced. Therefore if thyroid hormone replacement therapy is instituted in a client who has been taking warfarin, the dosage of warfarin should be reduced. A male client is on enalapril (Vasotec) for the treatment of hypertension. The nurse teaches the client that he should seek emergent care if he experiences which adverse effect? 1. Nausea 2. Insomnia 3. Dry cough 4. Swelling of the tongue - Correct Answer 4 Enalapril is an angiotensin-converting enzyme inhibitor. Angioedema is an adverse effect. Swelling of the tongue and lips can result in airway occlusion. Nausea, insomnia, and a cough can occur as side, not adverse effects of the medication. What should the nurse teach a client about an expected outcome of nesiritide (Natrecor) administration? 1. The client will have an increase in urine output. 2. The client will have an absence of dysrhythmias. 3. The client will have an increase in blood pressure. 4. The client will have an increase in pulmonary capillary wedge pressure. - Correct Answer 1 Nesiritide is a recombinant version of human B-type natriuretic peptide, which vasodilates arteries and veins. It is used for the treatment of decompensated heart failure, increases renal glomerular filtration, and increases urine output. The remaining options are incorrect about the intended effect of this medication. The nurse is caring for a client who is receiving dopamine. Which potential problem is a priority concern for this client? 1. Fluid overload 2. Peripheral vasoconstriction