Nursing Care for Patients with Cardiovascular Conditions, Exams of Nursing

Download Nursing Care for Patients with Cardiovascular Conditions and more Exams Nursing in PDF only on Docsity!

Lewis's Medical-Surgical Nursing, 11th Edition Chapter 31 - 37

Review Questions 2024-205 exam

Which anatomic feature of the heart directly stimulates ventricular contractions?

SA node

AV node

Bundle of His

Purkinje fibers - answer>>>Purkinje fibers

Rationale:

The Purkinje fibers move the electrical impulse or action potential through the walls of both ventricles triggering synchronized right and left ventricular contraction. The sinoatrial (SA) node initiates the electrical impulse that results in atrial contraction. The atrioventricular (AV) node receives the electrical impulse through internodal pathways. The bundle of His receives the impulse from the AV node.

The patient with chronic heart failure is being discharged from the hospital. What information should the nurse emphasize in the patient's discharge teaching to prevent progression of the disease to acute decompensated heart failure (ADHF)?

Take medications as prescribed.

Use oxygen when feeling short of breath.

Direct questions only to the health care provider.

Encourage most activity in the morning when rested. - answer>>>Take medications as prescribed.

Rationale:

The goal for the patient with chronic HF is to avoid exacerbations and hospitalization. Taking the medications as prescribed along with nondrug therapies such as alternating activity with rest will help the patient meet this goal. If the patient needs to use oxygen at home, it will probably be used all the time or with activity to prevent respiratory acidosis. Many HF patients are monitored by a care manager or in a transitional program to assess the patient for medication effectiveness and monitor for patient deterioration and encourage the patient. This

nurse manager can be asked questions or can contact the health care provider if there is evidence of worsening HF.

An asymptomatic patient with acute decompensated heart failure (ADHF) suddenly becomes dyspneic. Before dangling the patient on the bedside, what should the nurse assess first?

Urine output

Heart rhythm

Breath sounds

Blood pressure - answer>>>Blood pressure

Rationale:

The nurse should evaluate the blood pressure before dangling the patient on the bedside because the blood pressure can decrease as blood pools in the periphery and preload decreases. If the patient's blood pressure is low or marginal, the nurse should put the patient in the semi-Fowler's position and use other measures to improve gas exchange.

Which aspect of the heart's action does the QRS complex on the ECG represent?

Depolarization of the atria

Repolarization of the ventricles

Depolarization from atrioventricular (AV) node throughout ventricles

The length of time it takes for the impulse to travel from the atria to the ventricles - answer>>>Depolarization from atrioventricular (AV) node throughout ventricles

Rationale:

The QRS recorded on the ECG represents depolarization from the AV node throughout the ventricles. The P wave represents depolarization of the atria. The T wave represents repolarization of the ventricles. The interval between the PR and QRS represents the length of time it takes for the impulse to travel from the atria to the ventricles.

A patient with a long-standing history of heart failure recently qualified for hospice care. What measure should the nurse now prioritize when providing care for this patient?

Taper the patient off his current medications.

Continue education for the patient and his family.

Pursue experimental therapies or surgical options.

Choose interventions to promote comfort and prevent suffering. - answer>>>Choose interventions to promote comfort and prevent suffering.

Rationale:

The central focus of hospice care is the promotion of comfort and the prevention of suffering. Patient education should continue, but providing comfort is paramount. Medications should be continued unless they are not tolerated. Experimental therapies and surgeries are not used in the care of hospice patients.

An older adult patient with chronic heart failure (HF) and atrial fibrillation asks the nurse why warfarin (Coumadin) has been prescribed to continue at home. What is the best response by the nurse?

"The medication prevents blood clots from forming in your heart."

"The medication dissolves clots that develop in your coronary arteries."

"The medication reduces clotting by decreasing serum potassium levels."

"The medication increases your heart rate so that clots do not form in your heart." - answer>>>"The medication prevents blood clots from forming in your heart."

Rationale:

Chronic HF causes enlargement of the chambers of the heart and an altered electrical pathway, especially in the atria. When numerous sites in the atria fire spontaneously and rapidly, atrial fibrillation occurs. Atrial fibrillation promotes thrombus formation within the atria with an increased risk of stroke and requires treatment with cardioversion, antidysrhythmics, and/or anticoagulants. Warfarin is an anticoagulant that interferes with hepatic synthesis of vitamin K- dependent clotting factors.

The nurse is preparing to administer a nitroglycerin patch to a patient. When providing teaching about the use of the patch, what should the nurse include?

Avoid drugs to treat erectile dysfunction.

Increase diet intake of high-potassium foods.

Take an over-the-counter H2-receptor blocker.

Avoid nonsteroidal antiinflammatory drugs (NSAIDS). - answer>>>Avoid drugs to treat erectile dysfunction.

Rationale:

The use of erectile drugs concurrent with nitrates creates a risk of severe hypotension and possibly death. NSAIDs do not pose a risk in combination with nitrates. There is no need to take an H2-receptor blocker or increase the dietary intake of high-potassium foods.

What should the nurse recognize as an indication for the use of dopamine in the care of a patient with heart failure?

Acute anxiety

Hypotension and tachycardia

Peripheral edema and weight gain

Paroxysmal nocturnal dyspnea (PND) - answer>>>Hypotension and tachycardia

Rationale:

Dopamine is a β-adrenergic agonist whose inotropic action is used for treatment of severe heart failure accompanied by hemodynamic instability. Such a state may be indicated by tachycardia accompanied by hypotension. PND, anxiety, edema, and weight gain are common signs and symptoms of heart failure, but these do not necessarily warrant the use of dopamine.

The nurse observes ventricular tachycardia (VT) on the patient's monitor. What evaluation made by the nurse led to this interpretation?

Unmeasurable rate and rhythm

Rate 150 beats/min; inverted P wave

Rate 200 beats/min; P wave not visible

Rate 125 beats/min; normal QRS complex - answer>>>Rate 200 beats/min; P wave not visible

Rationale:

VT is associated with a rate of 150 to 250 beats/min; the P wave is not normally visible. Rate and rhythm are not measurable in ventricular fibrillation. P wave inversion and a normal QRS complex are not associated with VT.

The nurse has obtained this rhythm strip from her patient's monitor. What should the nurse document this rhythm indicates?

Sinus tachycardia

Sinus bradycardia

Ventricular fibrillation

Ventricular tachycardia - answer>>>Sinus tachycardia

Rationale:

This rhythm strip shows sinus tachycardia because the rate on this strip is above 101 beats/min, and it displays normal P wave, PR interval, and QRS complex. Sinus bradycardia would look similar to sinus tachycardia but with a rate less than 60 beats/min. Ventricular fibrillation does not have a measureable heart rate, PR interval, or QRS. The P wave is not visible, and the rhythm is irregular and chaotic. Ventricular tachycardia has a rate of 150 to 250 beats/min, with a regular or irregular rhythm and P waves occurring independently of the QRS complex.

A patient develops third-degree heart block and reports feeling chest pressure and shortness of breath. Which instructions should the nurse provide to the patient before initiating emergency transcutaneous pacing?

"The device will convert your heart rate and rhythm back to normal."

"The device uses overdrive pacing to slow the heart to a normal rate."

"The device is inserted through a large vein and threaded into your heart."

"The device delivers a current through your skin that can be uncomfortable." - answer>>>"The device delivers a current through your skin that can be uncomfortable."

Rationale:

Before initiating transcutaneous pacing therapy, it is important to tell the patient what to expect. The nurse should explain that the muscle contractions created by the pacemaker when the current passes through the chest wall are uncomfortable. Pacing for complete heart block will not convert the heart rhythm to normal. Overdrive pacing is used for very fast heart rates. Transcutaneous pacing is delivered through pacing pads adhered to the skin.

The nurse obtains a 6-second rhythm strip and charts the following analysis:

Tab 1: Atrial data

Rate: 70, regular Variable PR interval Independent beats

Tab 2: Ventricular data

Rate: 40, regular Isolated escape beats

Tab 3: Additional data

QRS: 0.04 sec P wave and QRS complexes unrelated

What is the correct interpretation of this rhythm strip?

Sinus dysrhythmia

Third-degree heart block

Wenckebach phenomenon

Premature ventricular contractions - answer>>>Third-degree heart block

Rationale:

Third-degree heart block represents a loss of communication between the atrium and ventricles from atrioventricular node dissociation. This is depicted on the rhythm strip as no relationship between the P waves (representing atrial contraction) and QRS complexes (representing ventricular contraction). Whereas the atria are beating totally on their own at 70 beats/min, the ventricles are pacing themselves at 40 beats/min. Sinus dysrhythmia is seen with a slower heart

rate with exhalation and an increased heart rate with inhalation. In Wenckebach heart block, there is a gradual lengthening of the PR interval until an atrial impulse is nonconducted and a QRS complex is blocked or missing. Premature ventricular contractions are the early occurrence of a wide, distorted QRS complex.

The nurse observes a flat line on the patient's monitor and the patient is unresponsive without pulse. What medications does the nurse prepare to administer?

Lidocaine or amiodarone

Digoxin and procainamide

Epinephrine or vasopressin

β-Adrenergic blockers and dopamine - answer>>>Epinephrine or vasopressin

Rationale:

Normally, the patient in asystole cannot be successfully resuscitated. However, administration of epinephrine or vasopressin may prompt the return of depolarization and ventricular contraction. Lidocaine and amiodarone are used for ventricular tachycardia or ventricular fibrillation. Digoxin and procainamide are used for ventricular rate control. β-Adrenergic blockers are used to slow heart rate, and dopamine is used to increase heart rate.

The nurse determines there is artifact on the patient's telemetry monitor. Which factor should the nurse assess for that could correct this issue?

Disabled automaticity

Electrodes in the wrong lead

Too much hair under the electrodes

Stimulation of the vagus nerve fibers - answer>>>Too much hair under the electrodes

Rationale:

Artifact is caused by muscle activity, electrical interference, or insecure leads and electrodes that could be caused by excessive chest wall hair. Disabled automaticity would cause an atrial dysrhythmia. Electrodes in the wrong lead will measure electricity in a different plane of the

heart and may have a different wave form than expected. Stimulation of the vagus nerve fibers causes a decrease in heart rate, not artifact.

The nurse observes no P waves on the patients monitor strip. There are fine, wavy lines between the QRS complexes. The QRS complexes measure 0.08 seconds (narrow), but they occur irregularly with a rate of 120 beats/min. What does the nurse determine the rhythm to be?

Sinus tachycardia

Atrial fibrillation

Ventricular fibrillation

Ventricular tachycardia - answer>>>Atrial fibrillation

Rationale:

Atrial fibrillation is represented on the cardiac monitor by irregular R-R intervals and small fibrillatory (f) waves. There are no normal P waves because the atria are not truly contracting, just fibrillating. Sinus tachycardia is a sinus rate above 100 beats/min with normal P waves. Ventricular fibrillation is seen on the ECG without a visible P wave; an unmeasurable heart rate, PR or QRS; and the rhythm is irregular and chaotic. Ventricular tachycardia is seen as three or more premature ventricular contractions that have distorted QRS complexes with regular or irregular rhythm, and the P wave is usually buried in the QRS complex without a measurable PR interval.

Which statement best describes the electrical activity of the heart represented by measuring the PR interval on the electrocardiogram (ECG)?

The length of time it takes to depolarize the atrium.

The length of time it takes for the atria to depolarize and repolarize.

The length of time for the electrical impulse to travel from the sinoatrial (SA) node to the Purkinje fibers.

The length of time it takes for the electrical impulse to travel from the sinoatrial (SA) node to the atrioventricular (AV) node. - answer>>>The length of time for the electrical impulse to travel from the sinoatrial (SA) node to the Purkinje fibers.

Rationale:

The electrical impulse in the heart must travel from the SA node through the AV node and into the Purkinje fibers in order for synchronous atrial and ventricular contraction to occur. When measuring the PR interval (the time from the beginning of the P wave to the beginning of the QRS), the nurse is identifying the length of time it takes for the electrical impulse to travel from the SA node to the Purkinje fibers. The P wave represents the length of time it takes for the impulse to travel from the SA node through the atrium, causing depolarization of the atria (atrial contraction). Atrial repolarization occurs during ventricular depolarization and is hidden by the QRS complex. The length of time it takes for the electrical impulse to travel from the SA node to the AV node is the flat line between the end of the P wave and the beginning of the Q wave on the ECG and is not usually measured.

The patient has a potassium level of 2.9 mEq/L, and the nurse obtains the following measurements on the rhythm strip: Heart rate of 86 with a regular rhythm, the P wave is 0. seconds (sec) and normal shape, the PR interval is 0.24 seconds, and the QRS is 0.09 seconds. How should the nurse document this rhythm?

First-degree AV block

Second-degree AV block

Premature atrial contraction (PAC)

Premature ventricular contraction (PVC) - answer>>>First-degree AV block

Rationale:

In first-degree atrioventricular (AV) block, there is prolonged duration of AV conduction that lengthens the PR interval above 0.20 seconds. In type I second-degree AV block, the PR interval continues to increase in duration until a QRS complex is blocked. In type II, the PR interval may be normal or prolonged, the ventricular rhythm may be irregular, and the QRS is usually greater than 0.12 seconds. PACs cause an irregular rhythm with a different-shaped P wave than the rest of the beats, and the PR interval may be shorter or longer. PVCs cause an irregular rhythm, and the QRS complex is wide and distorted in shape.

The nurse is caring for a patient who is 24 hours after pacemaker insertion. Which nursing intervention is appropriate at this time?

Reinforcing the pressure dressing as needed

Encouraging range-of-motion exercises of the involved arm

Assessing the incision for any redness, swelling, or discharge

Applying wet-to-dry dressings every 4 hours to the insertion site - answer>>>Assessing the incision for any redness, swelling, or discharge

Rationale:

After pacemaker insertion, it is important for the nurse to observe signs of infection by assessing for any redness, swelling, or discharge from the incision site. The nonpressure dressing is kept dry until removed, usually 24 hours postoperatively. It is important for the patient to limit activity of the involved arm to minimize pacemaker lead displacement.

A patient informs the nurse of experiencing syncope. Which prioitiy nursing action should the nurse anticipate in the patient's subsequent diagnostic workup?

Preparing to assist with a head-up tilt-test

Assessing the patient's knowledge of pacemakers

Administering an IV dose of a β-adrenergic blocker

Teaching the patient about antiplatelet aggregators - answer>>>Preparing to assist with a head- up tilt-test

Rationale:

In patients without structural heart disease, the head-up tilt-test is a common component of the diagnostic workup after episodes of syncope. IV β-blockers are not indicated, although an IV infusion of low-dose isoproterenol may be started in an attempt to provoke a response if the head-up tilt-test did not have a response. Addressing pacemakers is premature and inappropriate at this stage of diagnosis. Patient teaching surrounding antiplatelet aggregators is not directly relevant to the patient's syncope at this time.

The patient is admitted with acute coronary syndrome (ACS). The ECG shows ST-segment depression and T-wave inversion. What should the nurse know that this indicates?

Myocardia injury

Myocardial ischemia

Myocardial infarction

Normal pacemaker function. - answer>>>Myocardial ischemia

Rationale:

The ST depression and T wave inversion on the ECG of a patient diagnosed with ACS indicate myocardial ischemia from inadequate supply of blood and oxygen to the heart. Myocardial injury is identified with ST-segment elevation. Myocardial infarction is identified with ST- segment elevation and a widened and deep Q wave. A pacemaker's presence is evident on the ECG by a spike leading to depolarization and contraction.

When computing a heart rate from the electrocardiography (ECG) tracing, the nurse counts 15 of the small blocks between the R waves of a patient whose rhythm is regular. What does the nurse calculate the patient's heart rate to be?

60 beats/min

75 beats/min

100 beats/min

150 beats/min - answer>>>100 beats/min

Rationale:

Because each small block on the ECG paper represents 0.04 seconds, 1500 of these blocks represents 1 minute. By dividing the number of small blocks (15, in this case) into 1500, the nurse can calculate the heart rate in a patient whose rhythm is regular (in this case, 100).

Cardioversion is attempted for a patient with atrial flutter and a rapid ventricular response. After delivering 50 joules by synchronized cardioversion, the patient develops ventricular fibrillation. Which action should the nurse take immediately?

Administer 250 mL of 0.9% saline solution IV by rapid bolus.

Assess the apical pulse, blood pressure, and bilateral neck vein distention.

Turn the synchronizer switch to the "off" position and recharge the device.

Ask the patient if there is any chest pain or discomfort and administer morphine sulfate. - answer>>>Turn the synchronizer switch to the "off" position and recharge the device.

Rationale:

Ventricular fibrillation produces no effective cardiac contractions or cardiac output. If during synchronized cardioversion the patient becomes pulseless or the rhythm deteriorates to ventricular fibrillation, the nurse should turn the synchronizer switch off and initiate defibrillation. Fluids, additional assessment, or treatment of pain alone will not restore an effective heart rhythm.

The nurse is monitoring the electrocardiograms of several patients on a cardiac telemetry unit. The patients are directly visible to the nurse, and all the patients are observed to be sitting up and talking with visitors. Which patient's rhythm would require the nurse to take immediate action?

A 62-yr-old man with a fever and sinus tachycardia with a rate of 110 beats/min

A 72-yr-old woman with atrial fibrillation with 60 to 80 QRS complexes per minute

A 52-yr-old man with premature ventricular contractions (PVCs) at a rate of 12 per minute

A 42-yr-old woman with first-degree AV block and sinus bradycardia at a rate of 56 beats/min - answer>>>A 52-yr-old man with premature ventricular contractions (PVCs) at a rate of 12 per minute

Rationale:

Frequent premature ventricular contractions (PVCs) (>1 every 10 beats) may reduce the cardiac output and precipitate angina and heart failure, depending on their frequency. Because PVCs in CAD or acute myocardial infarction indicate ventricular irritability, the patient's physiologic response to PVCs must be monitored. Frequent PVCs may be treated with oxygen therapy, electrolyte replacement, or antidysrhythmic agents.

The patient has atrial fibrillation with a rapid ventricular response. What electrical treatment option does the nurse prepare the patient for?

Defibrillation

Synchronized cardioversion

Automatic external defibrillator (AED)

Implantable cardioverter-defibrillator (ICD) - answer>>>Synchronized cardioversion

Rationale:

Synchronized cardioversion is planned for a patient with supraventricular tachydysrhythmias (atrial fibrillation with a rapid ventricular response). Defibrillation or AEDs are the treatment of choice to end ventricular fibrillation and pulseless ventricular tachycardia (VT). An ICD is used with patients who have survived sudden cardiac death, have spontaneous sustained VT, and are at high risk for future life-threatening dysrhythmias.

The nurse prepares to defibrillate a patient. Which dysrhythmia has the nurse observed in this patient?

Ventricular fibrillation

Third-degree AV block

Uncontrolled atrial fibrillation

Ventricular tachycardia with a pulse - answer>>>Ventricular fibrillation

Rationale:

Defibrillation is always indicated in the treatment of ventricular fibrillation. Drug treatments are normally used in the treatment of uncontrolled atrial fibrillation and for ventricular tachycardia with a pulse (if the patient is stable). Otherwise, synchronized cardioversion is used (if the patient has a pulse). Pacemakers are the treatment of choice for third-degree heart block.

A patient reporting dizziness and shortness of breath is admitted with a dysrhythmia. Which medication, if ordered, requires the nurse to carefully monitor the patient for asystole?

Digoxin

Adenosine

Metoprolol

Atropine sulfate - answer>>>Adenosine

Rationale:

IV adenosine is the first drug of choice to convert supraventricular tachycardia to a normal sinus rhythm. Adenosine is administered IV rapidly (over 1 or 2 seconds) followed by a rapid, normal saline flush. The nurse should monitor the patient's electrocardiogram continuously because a brief period of asystole after adenosine administration is common and expected. Atropine sulfate increases heart rate, while lanoxin and metoprolol slow the heart rate.

The nurse performs discharge teaching for a patient with an implantable cardioverter- defibrillator (ICD). Which statement by the patient indicates that further teaching is needed?

"The device may set off the metal detectors in an airport."

"My family needs to keep up to date on how to perform CPR."

"I should not stand next to antitheft devices at the exit of stores."

"I can expect redness and swelling of the incision site for a few days." - answer>>>"I can expect redness and swelling of the incision site for a few days."

Rationale:

Patients should be taught to report any signs of infection at incision site (e.g., redness, swelling, drainage) or fever to their primary care providers immediately. Teach patients to inform TSA airport security of the presence of the ICD because it may set off metal detectors. If a handheld screening wand is used, it should not be placed directly over the ICD. Teach patients to avoid standing near antitheft devices in doorways of stores and public buildings and to walk through them at a normal pace. Caregivers should learn cardiopulmonary resuscitation.

The nurse is doing discharge teaching with the patient who received an implantable cardioverter-defibrillator (ICD) in the left side. Which statement by the patient indicates that further teaching is required?

"I will call the cardiologist if my ICD fires."

"I cannot fly because it will damage the ICD."

"I cannot move my left arm until it is approved."

"I cannot drive until my cardiologist says it is okay." - answer>>>"I cannot fly because it will damage the ICD."

Rationale:

The patient statement that flying will damage the ICD indicates misunderstanding about flying. The patient should be taught to inform TSA security screening agents at the airport about the ICD because it may set off the metal detector and if a hand-held screening wand is used, it should not be placed directly over the ICD. The other options indicate the patient understands the teaching.

The nurse provides discharge instructions for a 40-yr-old woman newly diagnosed with cardiomyopathy. Which statement indicates that further teaching is necessary?

"I will avoid lifting heavy objects."

"I can drink alcohol in moderation."

"My family will need to take a CPR course."

"I will reduce stress by learning guided imagery." - answer>>>"I can drink alcohol in moderation."

Rationale:

Patients with cardiomyopathy should avoid alcohol consumption, especially in patients with alcohol-related dilated cardiomyopathy. Avoiding heavy lifting and stress, as well as family members learning CPR, are recommended teaching points.

An 80-yr-old patient with uncontrolled type 1 diabetes is diagnosed with aortic stenosis. When conservative therapy is no longer effective, the nurse knows that the patient will need to do or have what done?

Aortic valve replacement

Have a pacemaker inserted

Open commissurotomy (valvulotomy) procedure

Percutaneous transluminal balloon valvuloplasty (PTBV) procedure - answer>>>Percutaneous transluminal balloon valvuloplasty (PTBV) procedure

Rationale:

The PTBV procedure is best for this older adult patient who is a poor surgery candidate related to the uncontrolled type 1 diabetes. Aortic valve replacement would probably not be tolerated

well by this patient, although it may be done if the PTBV fails and the diabetes is controlled in the future. Open commissurotomy procedure is used for mitral stenosis. The patient is not a candidate for a pacemaker.

A 72-yr-old man with a history of aortic stenosis is admitted to the emergency department. He reports severe left-sided chest pressure radiating to the jaw. Which medication, if ordered by the health care provider, should the nurse question?

Aspirin

Oxygen

Nitroglycerin

Morphine sulfate - answer>>>Nitroglycerin

Rationale:

Aspirin, oxygen, nitroglycerin, and morphine sulfate are all used to treat acute chest pain suspected to be caused by myocardial ischemia. However, nitroglycerin should be used cautiously or avoided in patients with aortic stenosis as a significant reduction in blood pressure may occur. Chest pain can worsen because of a decrease in blood pressure.

What should the nurse teach the patient who has had a valve replacement with a biologic valve?

Long-term anticoagulation therapy

Antibiotic prophylaxis for dental care

Exercise plan to increase cardiac tolerance

β-Adrenergic blockers to control palpitations - answer>>>Antibiotic prophylaxis for dental care

Rationale:

The patient will need to use antibiotic prophylaxis for dental care to prevent endocarditis. Long- term anticoagulation therapy is not used with biologic valve replacement unless the patient has atrial fibrillation. An exercise plan to increase cardiac tolerance is needed for a patient with heart failure. Taking β-adrenergic blockers to control palpitations is prescribed for mitral valve prolapse, not valve replacement.

On admission to the emergency department, a patient with cardiomyopathy has an ejection fraction of 10%. On assessment, the nurse notes bilateral crackles and shortness of breath. Which additional assessment finding would most indicate patient decline?

Increased heart rate

Increased blood pressure

Decreased respiratory rate

Decreased level of consciousness - answer>>>Decreased level of consciousness

Rationale:

Decreased level of consciousness indicates a lack of perfusion, hypoxia, or both. A patient with an ejection fraction of 10% indicates very low cardiac output. Bilateral crackles and shortness of breath are consistent with decompensating heart failure. The nurse would expect an increase in heart rate, blood pressure, and respiratory rate in response to the low ejection fraction. When blood pressure drops, the nurse would be aware of potential shock.

While admitting a patient with pericarditis, the nurse will assess for what manifestations of this disorder?

Pulsus paradoxus

Prolonged PR intervals

Widened pulse pressure

Clubbing of the fingers - answer>>>Pulsus paradoxus

Rationale:

Pericarditis can lead to cardiac tamponade, an emergency situation. Pulsus paradoxus greater than 10 mm Hg is a sign of cardiac tamponade that should be assessed at least every 4 hours in a patient with pericarditis. Prolonged PR intervals occur with first-degree AV block. Widened pulse pressure occurs with valvular heart disease and increased intracranial pressure. Clubbing of fingers may occur in subacute forms of infective endocarditis and valvular heart disease.

A 55-yr-old female patient develops acute pericarditis after a myocardial infarction. Which assessment finding indicates a possible complication?

Presence of a pericardial friction rub

Distant and muffled apical heart sounds

Increased chest pain with deep breathing

Decreased blood pressure with tachycardia - answer>>>Decreased blood pressure with tachycardia

Rationale:

Cardiac tamponade is a serious complication of acute pericarditis. Signs and symptoms include narrowed pulse pressure, tachypnea, tachycardia, a decreased cardiac output, and decreased blood pressure. The other symptoms are consistent with acute pericarditis.

A 25-yr-old patient with a group A streptococcal pharyngitis does not want to take the antibiotics prescribed. How should the nurse respond?

"You will not feel well if you do not take the medicine and get over this infection."

"Once you have been treated for a group A streptococcal infection, you will not get it again."

"Without treatment, you could get rheumatic fever, which can lead to rheumatic heart disease."

"You may not want to take the antibiotics for this infection, but you will be sorry if you do not."

• answer>>>"Without treatment, you could get rheumatic fever, which can lead to rheumatic heart disease."

Rationale:

Rheumatic fever (RF) is not common because of effective use of antibiotics to treat streptococcal infections. Without treatment, RF can occur and lead to rheumatic heart disease, especially in young adults. Saying that the patient will not feel well or that the patient will be sorry if the antibiotics are not taken is threatening to the patient and inappropriate for the nurse to say. Patients may have reoccurring infection of group A streptococcus.

The patient with pericarditis is reporting chest pain. After assessment, which intervention should the nurse expect to implement to provide pain relief?

Corticosteroids

Morphine sulfate

Proton pump inhibitor

Nonsteroidal antiinflammatory drugs - answer>>>Nonsteroidal antiinflammatory drugs

Rationale:

Nonsteroidal antiinflammatory drugs (NSAIDs) control pain and inflammation. Corticosteroids are reserved for patients already taking corticosteroids for autoimmune conditions and those who do not respond to NSAIDs. Morphine is not necessary. Proton pump inhibitors are used to decrease stomach acid to avoid the risk of gastrointestinal bleeding from the NSAIDs.

The nurse conducts a complete physical assessment on a patient admitted with infective endocarditis. Which finding is significant?

Regurgitant murmur at the mitral valve area

Point of maximal impulse palpable in fourth intercostal space

Heart rate of 94 beats/min and capillary refill time of 2 seconds

Respiratory rate of 18 breaths/min and heart rate of 90 beats/min - answer>>>Regurgitant murmur at the mitral valve area

Rationale:

A regurgitant murmur of the aortic or mitral valves would indicate valvular disease, which is a complication of endocarditis. All the other findings are within normal limits.

The nurse is teaching a community group about preventing rheumatic fever. What information should the nurse include?

Prompt recognition and treatment of streptococcal pharyngitis

Avoiding respiratory infections in children born with heart defects

Completion of 4 to 6 weeks of antibiotic therapy for infective endocarditis

Requesting antibiotics before dental surgery for individuals with rheumatoid arthritis - answer>>>Prompt recognition and treatment of streptococcal pharyngitis

Rationale:

The nurse should emphasize the need for prompt and adequate treatment of streptococcal pharyngitis infection, which can lead to the complication of rheumatic fever.

When caring for a patient with infective endocarditis, the nurse will assess the patient for which vascular manifestations? (Select all that apply.)

Osler's nodes

Janeway's lesions

Splinter hemorrhages

Subcutaneous nodules

Erythema marginatum lesions - answer>>>Osler's nodes

Janeway's lesions

Splinter hemorrhages

Rationale:

Osler's nodes, Janeway's lesions, and splinter hemorrhages are all vascular manifestations of infective endocarditis. Subcutaneous nodules and erythema marginatum lesions occur with rheumatic fever.

Which patients are most at risk for developing endocarditis? (Select all that apply.)

Older woman with histoplasmosis

Man with reports of chest pain and dyspnea

Man who is homeless with history of IV drug use

Patient with end-stage renal disease on peritoneal dialysis

Adolescent with exertional palpitations and clubbing of fingers

Female with peripheral intravenous site for medication administration - answer>>>Man who is homeless with history of IV drug use

Patient with end-stage renal disease on peritoneal dialysis

Rationale:

Intravenous drug use, especially if reusing or sharing needles are at risk of developing sepsis. In addition, risk for infection is increased in the elderly, homeless, and those with chronic illness. Peritoneal dialysis requires strict sterile technique to prevent peritonitis. Chest pain, shortness of breath, and palpitations may be signs of endocarditis. Clubbing of the fingers indicates long- term hypoxia. Central venous catheters, not peripheral, increase risk to for infective endocarditis. Patients with fungal infections, such as histoplasmosis and candida, are at risk for pericarditis.

A patient who has myocarditis now has fatigue, weakness, palpitations, and dyspnea at rest. The nurse assesses pulmonary crackles, edema, and weak peripheral pulses. Sinoatrial tachycardia is evident on the cardiac monitor. The Doppler echocardiography shows dilated cardiomyopathy. What should collaborative care accomplish to improve cardiac output and quality of life?

Decrease preload and afterload.

Relieve left ventricular outflow obstruction.

Improve diastolic filling and the underlying disease process.

Improve ventricular filling by reducing ventricular contractility. - answer>>>Decrease preload and afterload.

Rationale:

The patient has developed dilated cardiomyopathy. To improve cardiac output and quality of life, drug, nutrition, and cardiac rehabilitation will be focused on controlling heart failure by decreasing preload and afterload. Relief of left ventricular outflow obstruction and improving ventricular filling by reducing ventricular contractility is done for hypertrophic cardiomyopathy. There are no specific treatments for restrictive cardiomyopathy, but interventions are aimed at improving diastolic filling and the underlying disease process.

The nurse is caring for a patient who received a mechanical aortic valve replacement 2 years ago. Current lab values include an international normalized ratio (INR) of 1.5, platelet count of 150,000/μL, and hemoglobin of 8.6g/dL. Which nursing action is most appropriate?

Assess the vital signs.

Start intravenous fluids.

Monitor for signs of bleeding.

Contact the health care provider. - answer>>>Contact the health care provider.

Rationale:

Patients with mechanical valve replacement are placed on anticoagulants and should be in a therapeutic INR range of 2.5 to 3.5. Administration of Coumadin (Warfarin) prolongs clotting time and prevents clot formation on the valve. The low INR would require a call to the health care provider for an order increase the medication dose. Vital signs would be unchanged related to the low INR. Intravenous fluids are not indicated. The patient is at risk of forming clots, not bleeding.

Which assessment findings of the left lower extremity would the nurse identify as consistent with arterial occlusion? (Select all that apply.)

Edematous

Cold and mottled

Reports of paresthesia

Pulse not palpable with Doppler

Warmer than right lower extremity

Capillary refill less than 3 seconds - answer>>>Cold and mottled

Reports of paresthesia

Pulse not palpable with Doppler

Rationale:

Arterial occlusion may result in loss of limb if not timely revascularized. When an artery is occluded, perfusion to the extremity is impaired or absent. On assessment, the nurse would

note a cold, mottled extremity with impaired sensation or numbness. The pulse would not be identified, even with a Doppler. In contrast, the nurse would find edema, erythema, and increased warmth in the presence of a venous occlusion (deep vein thrombosis). Capillary refill would be greater than 3 seconds in an arterial occlusion and less than 3 seconds with a venous occlusion.

A nurse is caring for a patient with a diagnosis of deep venous thrombosis (DVT). The patient has an order to receive 30 mg enoxaparin (Lovenox). Which injection site should the nurse use to administer this medication safely?

Buttock, upper outer quadrant

Abdomen, anterior-lateral aspect

Back of the arm, 2 in away from a mole

Anterolateral thigh, with no scar tissue nearby - answer>>>Abdomen, anterior-lateral aspect

Rationale:

Enoxaparin (Lovenox) is a low-molecular-weight (LMW) heparin that is given as a deep subcutaneous injection in the right and left anterolateral abdomen. All subcutaneous injections should be given away from scars, lesions, or moles.

When the patient is being examined for venous thromboembolism (VTE) in the calf, what diagnostic test should the nurse expect to teach the patient about first?

Duplex ultrasound

Contrast venography

Magnetic resonance venography

Computed tomography venography - answer>>>Duplex ultrasound

Rationale:

The duplex ultrasound is the most widely used test to diagnose VTE. Contrast venography is rarely used now. Magnetic resonance venography is less accurate for calf veins than pelvic and proximal veins. Computed tomography venography may be used but is invasive and much more expensive than the duplex ultrasound.

A 39-yr-old woman with a history of smoking and oral contraceptive use is admitted with a venous thromboembolism (VTE) and prescribed unfractionated heparin. What laboratory test should the nurse review to evaluate the expected effect of the heparin?

Platelet count

Activated clotting time (ACT)

International normalized ratio (INR)

Activated partial thromboplastin time (aPTT) - answer>>>Activated partial thromboplastin time (aPTT)

Rationale:

Unfractionated heparin can be given by continuous IV for VTE treatment. When given IV, heparin requires frequent laboratory monitoring of clotting status as measured by activated partial thromboplastin time (aPTT). Platelet counts can decrease as an adverse reaction to heparin.

The nurse is caring for a patient with a recent history of deep vein thrombosis (DVT) who is scheduled for an emergency appendectomy. Vitamin K is ordered for immediate administration. The international normalized ratio (INR) value is 1.0. Which nursing action is most appropriate?

Administer the medication as ordered.

Hold the medication and record in the electronic medical record.

Hold the medication until the lab result is repeated to verify results.

Administer the medication and seek an increased dose from the health care provider. - answer>>>Hold the medication and record in the electronic medical record.

Rationale:

Vitamin K is the antidote to warfarin (Coumadin), which the patient has likely been taking before admission for treatment of DVT. Warfarin is an anticoagulant that impairs the ability of the blood to clot. Therefore, it may be necessary to give vitamin K before surgery to reduce the risk of hemorrhage. However, the INR value is normal, and vitamin K is not required, so the medication would be held and recorded in the electronic medical record.

A patient with varicose veins has been prescribed compression stockings. Which nursing instruction would be appropriate?

"Try to keep your stockings on 24 hours a day, as much as possible."

"While you're still lying in bed in the morning, put on your stockings."

"Dangle your feet at your bedside for 5 minutes before putting on your stockings."

"Your stockings will be most effective if you can remove them several times a day." - answer>>>"While you're still lying in bed in the morning, put on your stockings."

Rationale:

The patient with varicose veins should apply stockings in bed before rising in the morning. Stockings should not be worn continuously and should not be removed several times daily. Dangling at the bedside before application is likely to decrease their effectiveness.

A postoperative patient asks the nurse why the provider ordered daily administration of enoxaparin (Lovenox). Which reply by the nurse is accurate?

"This medication will help prevent breathing problems after surgery, such as pneumonia."

"This medication will help lower your blood pressure to a safer level, which is very important after surgery."

"This medication will help prevent blood clots from forming in your legs until your level of activity, such as walking, returns to normal."

"This medication is a narcotic pain medication that will help take away any muscle aches caused by positioning on the operating room table." - answer>>>"This medication will help prevent blood clots from forming in your legs until your level of activity, such as walking, returns to normal."

Rationale:

Enoxaparin is an anticoagulant that is used to prevent DVTs postoperatively. All other options do not describe the action or purpose of enoxaparin.