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54 Cards in this Set

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Blood is ejected into the circulation as the chambers of the heart become smaller. The nurse recognizes that the importance of this action of the heart is as:
Systole p. 647
The nurse of a patient who is diagnosed as having damage to the layer of the heart responsible for the pumping action is aware the damage is in the:
Myocardium (Brunner, 647)
A patient who has had a myocardial infarction (MI) states that he is prone to constipation. The nurse advises him to establish a regular bowel regimen because straining to have a bowel movement may:
When straining during defecation, the patient bears down (Valsalva maneuver), which momentarily increases pressure on the baroreceptors. This triggers a vagal response, causing heart rate to slow and resulting in syncope in some patients (Brunner, 658

Straining at stool, which results in the Valsalva maneuver, has a striking effect on arterial blood pressure. During active straining, the flow of venous blood in the chest is temporarily impended because of intrathoracic pressure. This pressure tents to collapse the large veins in the chest. The atria and the ventricles receive less blood, and consequently less blood is ejected by the left ventricle. Cardiac output is decreased, and there is a transient drop in arterial pressure. Almost immediately after this period of hypotension, an increase in arterial pressure occurs; the pressure is elevated momentarily to a point far exceeding the original level (rebound phenomenon). In patients with hypertension, this compensatory reaction may be exaggerated greatly, and the peak pressure attained may be dangerously high- sufficient to rupture a major artery in the brain or elsewhere (Brunner, 1233)
A patient who has experienced an MI and his wife tell the nurse that they are nervous about resuming sexual activity after discharge, even though the doctor has stated that they may. The most appropriate advice to give the patient is: ?
Inform the patient that it is common for people with similar heart problems to worry about resuming sexual activity. Then ask the patient to talk about his concerns. P. 660-661

Provide adequate information about the physical demands of sexual activity and ways these demands can be modified. Physiologic demands are greatest during orgasm reaching 5-6 metabolic equivalents. This level of activity is equivalent to walking 3-4 miles per hour on a treadmill. MET before and after orgasm are closer to 3.7 METs. Sharing this information may make the Pt more comfortable about resuming normal sexual activity. Other issues: Medications may cause impotence in men, women should not become pregnant after MI (Brunner, 797)
5. When performing an assessment on a patient who is admitted with unstable angina, the nurse notes that the patient's nail beds and lips have a bluish tinge. The nurse would chart this as:
Peripheral cyanosis (Brunner, 662)
. When assessing heart sounds, the nurse is aware that the time between S2 and S1:
Corresponds to systole (Brunner, 665)
In preparation for a transesophageal echocardiography, the nurse must:
-assess patient for history of dysphagia or radiation therapy to the chest
-inform patient about test
-Patient must fast for 6 hours before the study
-An IV line is started for administering a sedative and any pharmacologic stress testing medications
-Patient is sustained on moderate sedation, defined as a state of depressed consciousness during which time the patient responds appropriately to commands and can maintain a patent airway
-Patient’s throat is anesthetized before the probe is inserted. The patient is then asked to swallow the probe until it is correctly positioned in the esophagus.
-BP, ECG, respiration and oxygen saturation are monitored throughout the study (Brunner, 673)
A patient admitted with angina who is scheduled for a cardiac catheterization asks the nurse about the reason for this test. The nurse informs the patient that a cardiac catheterization is ordered most commonly to:
Cardiac catheterization is most frequently used to diagnose CAD, assess coronary artery patency, and determine the extent of atherosclerosis based on the percentage of coronary artery obstruction. These results determine whether revascularization procedures including PCI or coronary artery bypass surgery may be of benefit to the patient. Cardiac catheterization is also used to diagnose pulmonary arterial hypertension or to treat stenotic heart valves via percutaneous balloon valvuloplasty (Brunner, 675).
For the nurse to assess right ventricular function and venous blood return in the patient, a central venous pressure (CVP) monitoring line is established. The results are a decreased central venous pressure, which indicates:
Reduced right ventricular preload most often caused by hypovolemia (Brunner, 678) This diagnosis can be substantiated when a rapid intravenous infusion causes the CVP to rise.
While auscultating heart sounds of a patient with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). The nurse should document this as a:
S3 Gallop p. 665
During the nursing report, the nurse receives information that a newly admitted patient has an S3 gallop sound. What is the best technique for the nurse to follow when auscultating the gallop?
(665) An S3 gallop is heard best with the patient lying on the left side. This sound occurs during rapid ventricular filling and it may represent a normal finding in children and young adults. And is heard in patients with myocardial disease or with HF and whose ventricles fail to eject all of their blood during systole. Place the bell of the stethoscope lightly , against the chest wall and the sounds are best heard at the apex of the heart, occasionally they be heard from the right ventricle at the sternum(802)herd with the bell of the stethoscope at the apex, occasionally left of the sternum.
. Upon evaluation of a patient's blood results, the nurse recognizes that an elevated brain (B-Type) natriuretic peptide (BNP) indicates the presence of which condition?
A BNP level of 51.2 pg/ml or greater is correlated with mild HF and levels greater than 1000 pg/ml are associated with sever HF.
What information will the nurse provide to the patient scheduled for an exercise stress test the following day in preparation for it?
(672) Patient is instructed to fast at least 4 hours before the test and to avoid stimulants such as tobacco and caffeine. Medications may be taken with sips of water. Physician may instruct the patient not to take certain cardiac medications before the test. Clothes and suitable rubber soled shoes should be worn. Explain what type of equipment, sensations, experiences may have during the test. Explain monitoring equipment, the need for an IV line, and that patient will be monitored 10-15min. after the test.
The nurse who is providing patient teaching related to an elevated homocysteine level informs the patient that elevations in homocysteine increase the patient's risk of:
cardiovascular disease
An elevated blood level of homocysteine, an amino acid, is thought to indicate a high risk for CAD, stroke, and peripheral vascular disease, although it is not an independent predictor of CAD. Homocysteine is linked to the development of atherosclerosis, the underlying disorder in CAD, stroke and peripheral vascular disease.
The nurse notes that leads I, II, and III differ from one another on the cardiac rhythm strip because:
The view of the lead(824) Helps identify where, when, and what abnormalities occur
A lead has a narrow peripheral field of vision, looking only at the electrical activity directly in front of it. P. 685
The nurse evaluating a rhythm strip notes that the wave forms that move to the top of the strip indicate:
Positive deflection(825)
While analyzing a rhythm strip, the nurse identifies the resting state of the heart by looking at the:
T wave- (Brun-826)
An adult patient has damage to the electrical conduction of the ventricles of the heart. The nurse would expect to see changes in the:
(687) RR interval is used to determine ventricular rhythm. So I would expect a change in the RR interval.
To find the heart rate from an ECG strip of a patient with a normal sinus rhythm, the nurse counts 20 small boxes between two R waves. The heart rate would be:
(687) Count the number of small boxes within the RR interval and divide 1500 by that number. 1500/20 = 75 bpm
An adult patient in the emergency room is anxious about his health status. The ECG rhythm strip shows a heart rate of 120 beats/min. Characteristics of sinus tachycardia rhythm are:
Sinus tachycardia occurs when the sinus node creates an impulse faster than the normal rate. Sinus tachycardia characteristics are:Ventricular and atrial rate is greater than 100 in the adult but usually less than 120. Ventricular and atrial rhythm is regular. QRS shape and duration is usually normal, but may be regularly abnormal. P wave normal and consistent shape, always in front of the QRS, but may be buried in the preceding T wave. PR interval consistent interval between .12 and .20 seconds. P:QRS ratio 1:1.(829-830)
A nursing intervention to assess the hemodynamic effects of a dysrhythmia on a patient would be to:
The nurse regularly evaluates blood pressure, pulse rate, and rhythm, rate and depth of respirations, and breath sounds to determine the dysrhythmia’s hemodynamic effect. The nurse also asks the patient about episodes of lightheadedness, dizziness, or fainting as part of the ongoing assessment. P. 699

obtain a 12-lead ECG, continuously monitor the patient, and analyze rhythm strips to track dysrhythmias. (pg 841)
Auscultates for extra heart sounds (especially s3 and s4) and for heart murmurs, measures blood pressure and determines pulse pressures. The rate and rhythm of apical and peripheral pulses are also assessed and any pulse deficit noted(841)
23. When caring for a patient with cardiac dysrhythmia, the most appropriate goal for the patient is to maintain:
To minimize the incidence of dysrhythmias to maintain Adequate cardiac output(699)
A patient reports feeling palpations, light headedness, and weakness. The nurse finds a pulse deficit when doing the assessment. This may be an indicator of:
Declining cardiac output. (698) Atrial fibrillation.

I am not definitely sure on this, so you may want to double check my answer, but I think it is an arterial dysrhythmia, Premature Arterial Complex (PAC).
A 12-lead EKG performed on a patient 4 hours after onset of chest pain reveals ST segment elevation. The nurse recognizes that this finding indicates:
Cardiac Ischemia = Myocardial Infartction (pg 686) you may want to double check
MI, in this type there is significant damage to myocardium.
. A nurse is assessing an ECG rhythm strip. The P wave and the QRS complexes are regular. The PR interval is 0.16 second. The overall heart rate is 60 beats/min. the nurse assesses the cardiac rhythm as:
Normal Sinus Rhythm(687)
patient is diagnosed as having elevated cholesterol level. The nurse is aware that plaque on the inner lumen of the arteries is composed chiefly of:
Lipids and inflammatory infiltrate, Macrophages (713)

FIbrous cap of smooth muscle forms over
The coronary arteries are susceptible to development of arteriosclerosis because coronary arteries:
The anatomic structure of the coronary arteries make them particularly susceptible to the mechanisms of atherosclerosis. (pg 713

The three major coronary arteries have multiple branches, atherolsclerotic lesions most often form where vessels branch, suggestion a hemodynamic component that favors their formation

Because they have multiple branches. Atherosclerotic lesions most often form where vessels branch, suggesting a hemodynamic component that favors their formation.
29. An adult patient who experiences angina pectoris with exertion is informed by the nurse that most often angina is caused by:
Coronary atherosclerosis.
(Increased myocardial oxygen demand- causes the pain with exertion), angina is usually caused by atherosclerotic disease. Almost invariably, angina is associated with a significant obstruction of a major coronary artery.( 719)
The nurse is teaching a 45-year-old patient about ways to lower elevated cholesterol levels. One method to lower cholesterol levels is to exercise which:
increases HDL levels and reduces triglyceride levels(717)
To relieve angina pectoris symptoms, the nurse administers nitroglycerin sublingual to the patient. Which of the following is an action of nitroglycerin? –
–Nitroglycerin dilates primarily veins but in high doses can dilate arteries.
-It reduces myocardial oxygen consumption, which decreases ischemia and relieves pain. -Filling pressure reduced because of vein dilatation.
-Sublingual administration can lower pain within 3 minutes.
-Helps increase coronary blood flow by preventing casospasm and increasing perfusion through the collateral vessels
-Can decrease cardiac output and blood pressure
-relx systemic arteriolar bed (decreased aferload)
-Decrease myocardial oxygen requirements and increase oxygen supply. More favorable balance

p. 721
An adult patient has symptoms of unstable angina during admission to the hospital. The most appropriate nursing diagnosis for the discomfort associated with angina is:
Ineffective cardiac tissue perfusion secondary to CAD, as evidenced by chest pain or equivalent symptoms. (723)
The most appropriate intervention for the nurse to take when a patient develops chest pain related to angina is to:
Nurse directs patient to discontinue all activities and sit and rest in bed in a semi-fowlers position to reduce oxygen requirements. Continually assess patient by measuring vital signs and observing for signs of respiratory distress. EKG if in the hospital. Nitroglycerin sublingual administered up to three times.

ST segment is monitored. The nurse administers oxygen if the patient’s respiratory rate is increased 2L/min NC p. 724
The nurse notes that there are changes in the ECG of a patient who experienced an MI. Changes may indicate that the occurring ischemia is:
Could be an extension of a myocardial ischemia(882)????
Changes on an ECG - might be a couple of things. 1) If there is new ST elevation or depression it could mean a recurrent MI or ischemia, or, 2) if the ST segment is returning to baseline, meaning the ST depression or elevation is becomming less, the MI is resolving. Clear as mud? Another change you might see in a person who has had an MI is a Q wave which was not present prior to the MI. THe presence of a Q wave indicates previous myocardial damage/MI and is a normal finding in a person who has had an MI before.

# 34
ischema injury/ healing, Depolarized/ repolarized, return to normal? P. 726

May be an extension of the MI, inadequate cardiac output
A patient is suspected of experiencing an MI at approximately 6:00 AM, at which time laboratory results show an increase in troponin I. The nurse can expect troponin I to peak at what time:
within 4-24 hours so anywhere from 10 A.M to 6 A.M the next morning. (727)

Peaks at approximately the same time as CK-MB. P. 727 elevated longer 1-3 weeks
A patient is admitted with pale, cool skin, midsternal chest pain unrelieved with rest, and a history of CAD. The nurse is aware that:
These signs indicate a possible MI (725)
The most appropriate expected patient outcome for the nursing diagnosis of deficient knowledge about post-MI self-care would be:
Adheres to home health care program, chooses lifestyle consistent with heart-healthy recommendations. P. 733

States appropriate activities to promote adequate self care, etc
) During PTCA, a patient who received a coronary artery stent is informed that she will need to take aspirin for the rest of her life. The nurse informs her that aspirin is prescribed to prevent:
Prevents platelet activation and reduces incidence of MI and death in patients with CAD 722

Aspirin is used to prevent and decrease the risk of thrombus formation in the stent. (886)
In the preoperative phase of the patient awaiting cardiac surgery, a nurse should:
In the preoperative phase of the patient awaiting cardiac surgery, a nurse should:-Physical and psychological assessment should be obtained and established for future reference. The nurse assess the patient for disorders that could complicate or affect postoperative course including diabetes, hypertension, preexisting disabilities, and respiratory, gastrointestinal and hematological diseases. Clarifies medication directions before and after. Clarifies the need to maintain healthy life style to minimize risk of surgical risks. Reduce Fear.(Read more on pages 893-895)

The patient’s understanding of the procedure, informed consent, and adherence to treatment protocols are evaluated.

Helpin ghte patient to cope, understand the procedure, and maintain dignity are nursing responsibilities. P. 739
The nurse is doing health promotion and interviews a patient with a history of hypertension, who is currently smoking 1 pack of cigarettes per day. She has had no manifestations of coronary artery disease, but did have a recent LDL level of 154 mg/dL. Based on her assessment, the nurse would expect that the physician would treat this cholesterol level in which of the following ways?
Control through diet and exercise. Quit smoking.
I messed up on question 40. This patient has 2 risk factors, so her LDL is high(I was thinking it wasn't before). As a result treatment would probably include not only diet and exercise changes but also either a HMG--CoA reductase inhibitors or statin or a Nicotonic acid.
Diet, Exercise, smoking cessation!!! P. 717
The nurse caring for an elderly pt with CAD is teaching her about the clinical manifestations of an acute MI. The nurse emphasizes that she may not exhibit the typical pain profile because the presenting symptom in the elderly often is:
Dyspnea. If pain occurs it is atypical pain that radiates to both arms rather than just the left arm.(868)

Elderly people (And those with diabetes) may not have pain with MI because of neuropathies. Fatigue and shortness of breath may be the predominate symptoms in these patients. P. 655
The nurse is caring for a pt post-PTCA (percutaneous transluminal coronary angioplasty) who has returned to the nursing unit with a large peripheral vascular access sheath in place. An immediate nursing intervention includes:
Pt remaining flat in bed and keep the effective leg straight until the sheaths are removed and then for a few hours afterward to maintain homeostasis. (887)
Analgesics and sedations p. 735
The nurse notes that a pt has developed a cough productive for mucoid sputum, SOB, cyanotic hands, and noisy, moist-sounding, rapid breathing. These symptoms indicate:
Acute Heart Failure or Pulmonary Edema (805)
The nurse doing pt education with a 55-year-old male recently diagnosed with primary HTN who has no signs or symptoms of the disease is aware than an estimated 50% of pts discontinue their antihypertensive medications within one year of beginning them. Keeping this in mind, the nurse recommends which of the following to this pt:
Compliance increases when pts actively participate in self care including self-monitoring of BP and diet
p. 864
A nurse is caring for an elderly adult with HTN who is being treated with a diuretic and beta-blocker. The nurse is aware that a major consideration in managing HTN in the elderly is to:
educate and monitor orthostatic hypotension (1027), toxicity risk with decreased renal and liver function (1027), starting dose 1/2 that used in younger pts (1025).

: Ensure that medication regimen is understood and can see and read instructions, open the medication container and get the prescription refilled.(1031)Starting dose should be half that used in younger people.(1025)

If possible, Monotherapy is best for the elderly.
p. 864
The nurse is assessing a pt with primary HTN that has been well controlled for the past year. Today, the pt has an abnormally high BP. After interviewing the pt, the nurse realizes that the pt is experiencing rebound HTN due to:
"Rebound HTN can occur if antihypertensive medications are suddenly stopped." (p. 864)
The nurse is preparing to take a pt's blood pressure during a follow up assessment. Before taking the BP, the nurse should determine if the pt has:
Has avoided smoking cigarettes or drinking caffeine for 30 minutes before the blood pressure is measured. (864)
The nurse assessing the pt with a new diagnosis of HTN questions him about decreased visual acuity, which may indicate:
Retinal blood vessel damage indicates similar damage elsewhere in vascular system. Question pt about blurred vision, spots in front of eyes, diminished visual acuity. 864

Retinal changes such as hemorrhages, fluid accumulation, arteriolar narrowing, or cotton-wool spots or small infarctions. In severe hypertension swelling of the papilledema may occur (swelling of the optic nerve)
A pt with uncomplicated HTN is prescribed furosemide (Lasix). The nurse is aware that this medication is a:
860- Loop diuretic.
When uncontrolled hypertension is prolonged, the nurse is aware that the patient is at risk for developing which of the following complications?-
Prolonged blood pressure elevation eventually damages blood vessels throughout the body, particularly in target organs such as heart, kidneys, brain and eyes. The usual consequences of prolonged, uncontrolled HTN are myocardial infarction, heart failure, renal failure, strokes, and impaired vision. Hypertrophy of left ventricle of the heart may occur as it works to pump blood against the elevated pressure.
During an initial assessment by the nurse, a patient's blood pressure measures 160/90. When should the patient be instructed to have a follow-up assessment of his or her blood pressure?
Within one month
When educating a patient about risk factors for hypertension, the nurse recognizes the patient has comprehended the teaching when he states:
risk factors include: Increased sympathetic nervous system activity related to ANS dysfunction, Increased renal absorption of sodium chloride and water r/t kidney, Increased activity or renin angiotensin aldosterone system, decreased vasodilatation of arteriolesr/t dysfunction of vascular endothelium, resistance to insulin action. If it includes risk factors for cardiovascular problems in addition to hypertension I would include: smoking, elevated LDL's, diabetes mellitus, impaired renal function, obesity, physical inactivity, age ( 55 + for women and 65 + for men) family hx and stress.
Sleep apnea, drud incduced, chronic kidney disease, chronic steroid therapy and cushing’s syndrome, Pheochromocytome, Coarctation of the aorta, Thyroid or parathyroid disease p. 856

Excess sodium intake, fewer nephrons, stress, genetic alteration, obesity, endothelial factors. p. 857
A patient with primary hypertension is currently on an alpha-adrenergic blocker. He complains of dizziness with ambulation. The nurse assesses postural hypotension. When teaching this patient about risks associated with postural hypotension, emphasis should be placed on:
risk I would emphasize is "fall risk" due to dizziness, lightheadedness or syncope. Causes of postural hypotension are 1. reduced fluid/blood volume 2. inadequate vasoconstrictor mechanisms 3. insufficient autonomic effect on vascular constriction.
The nurse is developing a nursing care plan for a patient with primary hypertension who has not been adhering to the prescribed dietary regimen. One of the measurable patient outcomes may include
1. Maintians adequate tissue perfusion
a. Maintains blood pressure at less that 140/90 mm Hg with lifestyle modifications, medications, or both
b. Demonstrates no symptoms of angina, palpaitions, or vision changes
c. Has stable BUN and serum creatine levels
d. Has palpable peripheral pulses

p. 865

total blood cholesterol, HDL's, LDL's, triglyceride levels, serum blood levels and glucose blood levels.
A patient with primary hypertension is being seen in the physician's office for follow-up care. The nurse assessing response to antihypertensive drug therapy is aware that the goal of hypertensive treatment is to prevent complications and death by achieving and maintaining arterial BP at:
140/90 or less(1025)