Cardiac

Front 1

Know what medicationsto expect for a patient diagnosed with systolic heart failure

Back 1

Ace inhibitors, beta blockers, diuretics, and digitalis.

Front 2

Know the risk factorsfor patients at risk for heart failure

Back 2

Major risk factors include: age >65, male sex, leftventricular hypertrophy, MI, Valvular heart disease, and obesity

Minor risk factors include: excessive alcohol consumption,smoking, high cholesterol (dyslipidemia), diabetes, toxins (chemo agents),sleep-disordered breathing, chronic kidney disease, low socioeconomic status,psychological stress, sedentary lifestyle, and genetics.

Front 3

Patient teaching fora patient with heart failure

Back 3

It is important for the family to understand heart failure, andtheir importance of participation in the treatment regimen. Lifestyle recommendationsinclude restriction of sodium, avoidance of excessive fluid intake, alcohol andsmoking, weight reduction when indicated, and regular exercise. The patientmust know what signs and symptoms to recognize that need to be reported to theprovider such as weight gain, increasing SOB, fatigue and edema.

Front 4

How would you assessa patient with hepatojugular reflux related to heart failure

Back 4

the patient is positioned in the bed so that the nurse canobserve the blood column of the jugular veins above the clavicle, the patientis asked to breath normally while manual pressure is applied over the rightupper quadrant of the abdomen for at least 15 seconds, if the top of thejugular venous column in the neck rises and persists as long as the abdominalpressure is continued it is considered positive heptojugular reflux, which isassociated with right sided HF and constrictive pericarditis.

Front 5

Know the risk factorsfor cardiogenic shock (patho, s/s and treatment, education)

Back 5

Decreased cardiac output leads to inadequate tissueperfusion, could happen following an MI, when a large area of the myocardiumbecomes ischemic, necrotic, and hypokinetic. It can also occur as a result of endstage HF, cardiac tamponade, PE, cardiomyopathy, and arrhythmias.S/S reflect the circular nature of the patho of HF, thedegree of shock is proportional to the extent of left ventricular dysfunction,the heart loses its contractile power, resulting in a marked reduction in SVand CO, the decreased CO in turn reduces arterial BP and tissue perfusion inthe vital organs (heart, brain, lungs and kidneys), flow to the coronaryarteries is reduced resulting in decreased O2 supply to the myocardium, which increasesischemia and further reduces the hearts ability to pump, inadequate emptying ofthe ventricle also leads to increased pulmonary pressures, pulmonary congestion,and pulmonary edema, exacerbating the hypoxia, causing ischemia of vitalorgans, and setting a vicious cycle in motion.Most important correct the underlying issue, reduce any furtherdamage of the heart, improve oxygenation, and restore tissue perfusion. rons\"\ϙ

Front 6

What is pulsusparadoxus :

Back 6

Systolic BP that is markedly lower during inhalation

Front 7

The term that supportswhen a patient is showing no cardiac rhythm

Back 7

Asystole

Front 8

What would a nursehear (auscultate) during a physical assessment that may suspect heart failure

Back 8

S3 gallop sound is a sign heart is beginning to fail othersounds may include mitral and tricuspid regurgitation murmurs, and the nursemay hear an S4 if the patient has increased resistance to ventricular fillingbecause of increased stiffness of the ventricular myocardium.

Front 9

Explain the patho forpericardial sac fluid increase

Back 9

Greater than 50 ml of fluid in sacIncreased right and left ventricular end-diastolic pressuresDecreased venous return Inability of ventricles to distend and fill adequately Decreased cardiac output Which can lead to cardiac tamponade

Front 10

Difference betweendiastolic and systolic heart failure

Back 10

Systolic weakened heart muscle problem with contraction ofthe heart decreased blood volume being ejected from ventricleDiastolic stiff and noncompliant heart muscle problem withfilling of the heart develops because of increased workload of the heart

Front 11

Know if a patient hasdecrease cardiac output, and how it affects the kidneys and what process isinitiated.

Back 11

Causes the release of renin by the kidney and renin promotesthe formation of angiotensin 1 to angiotensin 2, a potent vasoconstrictor, abenign, inactive substance, ACE int eh lumen of the pulmosry muscles converts 1to 2, which then increases the BP and afterload, 2 stimulates the release ofaldosterone from the adrenal cortex, resulting in sodium retention by the renaltubules and stimulating the thirst center, this leads to fluid volume overloadwhich in then can lead to apart of HF.

Front 12

Heart Failure (patho, risk factors, s/s, treatment,patient teaching)

Back 12

Is the inability of the heart to pump sufficient blood tomeet the needs of the tissues for oxygen and nutrients and is currentlyrecognized as S/S of fluid overload or of inadequate tissue perfusion, the termindicates myocardial disease in which there is a problem with contraction ofthe heart or filling of the heart that may or may not cause pulmonary orsystemic congestion, most often HF is a progressive and lifelong diagnosis thatis managed with lifestyle changes and medications to prevent acute congestiveepisodes,

Front 13

How Ace inhibitorsand beta blockers work in the body for heart failure patients

Back 13

Ace inhibitors such as captopriland enalapril, block theconversion of angiotensin 1 to 2 , a vasoconstrictor that can raise BP andthese drugs alleviate HF symptoms by causing vasodialation and decreasingmyocardial workload and they are preload and afterload reducers and providerenal protection Beta blockers, such as bisoprolol, metroprolol, andcardeviolol, block the effects of the catecholines, resulting in reduction ofheart rate, peripheral vasoconstriction, and myocardial ischemia, they caninterfere with the passage of air into the lungs some avoid this and they arenegative inotrope.

Front 14

Pericardial effusion(patho risk factors, s/s, treatment and education)

Back 14

book

Front 15

What is the plan ofaction for a patient with loss if consciousness and non-palpable carotid pulse?

Back 15

call code blue then perform cpr

Front 16

Mitral Stenosis(patho, risk factors, s/s, treatment and education) what heart rhythm wouldmost likely be associated with mitral stenosis

Back 16

Paroxysmal nocturnal dyspnea and A fib

Front 17

Pericarditis (patho,risk factors, s/s, treatment and education)

Back 17

b

Front 18

Aortic Regurgitation(patho, risk factors, s/s, treatment and education)

Back 18

b

Front 19

Mitral valve prolapse(patho, risk factors, s/s, treatment and education)

Back 19

b

Front 20

Aortic stenosis(patho, risk factors, s/s, treatment and education)

Back 20

b

Front 21

Endocarditis (patho,risk factors, s/s, treatment and education) (cause of hospital acquiredendocarditis)

Back 21

With bactermia and an indwelling catheter and in patientswho are receiving prolonged iv fluids or antibiotic therapy

Front 22

DCM (Dilatedcardiomyopathy) (patho, risk factors, s/s, treatment and education)-characteristics seen with DCM

Back 22

b

Front 23

Percutaneous aorticballoon valvuloplasty vs valve replacement

Back 23

Patients who are asymptomatic and are not surgical candidatesmay benefit, but it has fallen out of favor because of little benefit with acalcific valve and a high rate of restenosis, it is recognized as a viablealternative to surgery in older adults with AS and other poor surgical candidatessuch as pregnant woman.Is definitive treatment for AS and is recommended for allpatients with severe symptoms, timing of surgery is based on the naturalprogression of the disease, but it is important to note that once a patient developsangina, HF, or syncope, there is a significant decline in survival rate.p\pN

Front 24

Atrial septal defect(patho, risk factors, s/s, treatment education)

Back 24

b

Front 25

Heart Transplantation(know complications postop, teaching)

Back 25

Atropine does not increase the rate of transplanted hearts!Constantly balance the risk of rejection with the risk of infection,cardiac allograft vasculopathy, an accelerated, diffuse atherosclerosis of thecoronary arteries, this can result in coronary lumen loss, ischemia, infarction,and sudden death, post transplantation lymphoproliferative disease and cancerof the skin and lips are the most common malignancies after transplantation likelycaused by immunosuppression.angi\`N

Front 26

VAD (ventricularassist device)

Back 26

Complex devices that can perform all or all of the pumpingfunction for the heart and can support a failing heart by generating blood flowto the systemic circulation and unloading the ventricle.

Front 27

EKG (what the p wave,qrs complex and t wave, st segment represent) (atrial depolarization, ventricledepolarization, ventricle repolarization)

Back 27

The p wave represents the electrical impulse starting in thesinus node and spreading through the atria.QRS complex represents ventricular depolarization, the qwave is the first negative deflection after the p wave, r wave is the first positivedeflection after the p wave and s wave is the first negative deflection afterthe r wave. T wave represents ventricular repolarization or electricalrecovery. ST segment which represents early ventricular repolarization, lastsfrom the end of the QRS complex and is called the Jpoint. in su\yN

Front 28

Pacemaker (function)

Back 28

Is an electronic device that delivers electrical stimulationto the heart to regulate the heart rate when a patient has a slower than normalheart rate or conduction disturbance.

Front 29

CPR (function, whatto monitor for

Back 29

Airway breathing circulation defibrillation

Front 30

Cardioversion vsdefibrillation

Back 30

Elective procedure, client awake, synchronized with QRS,sedation, 50-200 joules, consent form, EKG monitorEmergency, v-fib/v-tach, no cardiac output star with 200joules up to 360, client unconscious, EKG monitor

Front 31

A fib (medicationtreatment)

Back 31

acute adenosine

warafin and cardioversion long term

Front 32

Junctional arrhythmia

Back 32

b

Front 33

VFib ( how to treat)

Back 33

Defibrillation, CPR, and activation of emergency servicesand vasoactive meds after second rhythm check.

Front 34

Third degree AV block( the cause of it)

Back 34

Caused by injury to the conduction system no atrial impulseis conducted through the AV node into the ventricles.

Front 35

V Tach ( related todecrease cardiac output) the cause of it

Back 35

Is usually associated with CAD and may precede v fib

Front 36

Catheter ablation

Back 36

Destroys specific cells that are the cause or centralconduction route of tachyarrhythmia.

Front 37

EP study(electrophysiology) what is the primary function of test

Back 37

Is an invasive procedure used to evaluate and treat significantarrhythmias,

Front 38

Cardiac conductionsurgery ( function)

Back 38

Atrial tachycardias and ventricular tachycardia’s that donot respond to meds and are not suitable for antitachycardia pacing may betreated by methods that include a maze procedure and ablation. Maze procedureis an open heart surgery procedure for refractory a fib.

Front 39

Know the goal oftreatment for a patient converting from NSR to AFIB

Back 39

electrical cardioversion

Front 40

Know accuracy inplacing EKG leads

Back 40

b

Front 41

Holter monitoring

Back 41

continuous monitoring for 24 hours

Front 42

A 40-year-old man who is normally in good health has presented to the emergency department with an acute onset of sharp, mid-chest pain that is exacerbated by movement. Diagnostic testing is negative for myocardial infarction (MI), causing the care team to suspect that the patient is experiencing what health problem?

Back 42

The signs and symptoms of pericarditis often mimic those of MI. Angina causes many of the same diagnostic findings as MI; negative tests for MI also rule out angina as a cause of the patient's signs and symptoms. Endocarditis is characterized by signs and symptoms of infection, and DCM normally has a more gradual course that involves fatigue and activity intolerance rather than acute chest pain.

The correct answer is: Pericarditis

Front 43

A 41-year-old IV heroin user has been admitted to the hospital with a diagnosis of infective endocarditis and begun on IV antibiotic therapy. The patient is eager to be discharged from the hospital and has asked the nurse when he is likely to be discharged. How should the nurse reply?

Back 43

The cornerstone of treatment is long-term, parenteral antibiotic therapy. It is administered in doses that produce a high serum concentration and for a significant period, often for upwards of 6 weeks to ensure eradication of the dormant bacteria within the dense vegetations. Antibiotic administration occurs several times daily, depending on the particular drug.

The correct answer is: “Endocarditis involves a very resilient infection, so it's common to need several weeks of IV antibiotics.”

Front 44

A 66-year-old man has presented to the emergency department with complaints of crushing chest pain. Consequently, an electrocardiogram (ECG) has been ordered stat. Which of the following actions should the nurse prioritize when facilitating this diagnostic test?

Back 44

Accurate and consistent lead placement are essential for a clinically meaningful ECG. This would supersede the immediate importance of patient education or family reassurance. The patient is not positioned prone for an ECG.

The correct answer is: Landmarking and placing the ECG electrodes accurately

Front 45

A 66-year-old man with a longstanding history of severe cardiomyopathy has been fortunate to receive a donor heart. In the weeks following the successful transplantation, which of the following problems is likely to pose the greatest threat to the patient?

Select one:

Back 45

Recovery from heart transplantation is a long and onerous process. Among the many potential problems associated with the procedure, rejection and infection are paramount. Valvular disorders, conduction problems, and ischemia are less likely challenges.

The correct answer is: Rejection of the donor heart

Front 46

A 69-year-old man has been experiencing progressive dyspnea and activity intolerance in recent months and is currently undergoing a diagnostic workup for heart failure (HF). During echocardiography, systolic HF could be differentiated from diastolic HF by appraising the patient's:

Back 46

An assessment of the EF is performed to assist in determining the type of HF. EF, an indication of the volume of blood ejected with each contraction, is calculated by subtracting the amount of blood at the end of systole from the amount at the end of diastole and calculating the percentage of blood that is ejected. The type of HF that a patient is experiencing cannot be determined solely by assessing heart rate or wall thickness. Stroke volume is a component of ejection fraction.

The correct answer is: Ejection fraction (EF)

Front 47

A 70-year-old man has been living with a diagnosis of heart failure (HF) for several years and has been vigilant about monitoring the trajectory of disease and adhering to his prescribed treatment regimen. The man has scheduled an appointment with his primary care provider because he has noted a weight gain of 6 pounds over the past week. The nurse should anticipate that this patient may benefit from which of the following treatment measures?

Back 47

If a patient with HF experiences a significant change in weight (ie, 2- to 3-lb increase in a day or 5-lb increase in a week), the patient is instructed to notify his or her provider or to adjust the medications (eg, increase the diuretic dose) per provider's directions. Thoracentesis is not relevant, and decreased activity may exacerbate the patient's condition. Decreased sodium intake may be of some benefit, but diuretics will have a greater effect.

The correct answer is: An increase in the dose of his prescribed diuretic

Front 48

A 71-year-old woman has a history of recurrent atrial arrhythmias and has consequently been scheduled for catheter ablation. The nurse who has been providing care for this patient should recognize that this procedure will address the patient's arrhythmia by:

Back 48

Catheter ablation destroys specific cells that are the cause or central conduction route of a tachyarrhythmia. Ablation does not “reset” sinus rhythm in the manner of defibrillation or cardioversion. As well, the procedure does not create an alternative conduction route. Implantation of an artificial device, such as a pacemaker, is not a component of catheter ablation.

The correct answer is: Destroying the specific cardiac cells that are causing the patient's arrhythmia

Front 49

A 73-year-old man with aortic stenosis has had percutaneous aortic balloon valvuloplasty performed because he is not a candidate for valve replacement. Following this procedure, the nurse should prioritize assessments related to:

Back 49

Potential complications of percutaneous aortic balloon valvuloplasty include aortic regurgitation, emboli, ventricular perforation, rupture of the aortic valve annulus, ventricular arrhythmias, mitral valve damage, and bleeding from the catheter insertion sites. The procedure is unlikely to result in cardiac ischemia or infection.

The correct answer is: Ventricular arrhythmias

Front 50

A 77-year-old woman who lives with her husband has undergone cardioversion twice in the past several months for the treatment of atrial fibrillation. When performing health education with the patient's husband, what subject matter should the nurse emphasize?

Back 50

Family members of individuals who have dysrhythmias should be taught the technique for CPR or referred to a course where these skills can be learned. It is not normally necessary to teach about the pharmacodynamics of medications or the specific rationale for an intervention that has been completed. A low-activity lifestyle is not usually a necessary management strategy for a patient with atrial fibrillation.The correct answer is: The correct technique for performing cardiopulmonary resuscitation

Front 51

A 79-year-old woman with a complex medical history has recently moved to a long-term care facility. The nurse reads in the woman's documentation that she has a history of atrial fibrillation and hypertension. The nurse should presume that this patient will likely be taking which of the following medications?

Back 51

Atrial fibrillation represents a significant risk of thromboembolism and stroke, especially among older adults with hypertension. These risks may be partially mitigated with daily administration of warfarin (Coumadin). The resident may be taking Lasix for the treatment of hypertension, but this does not address atrial fibrillation or its accompanying risks. Calcium carbonate and levothyroxine are not necessitated by this patient's history.The correct answer is: Warfarin (Coumadin)

Front 52

A community health nurse is participating in a healthy-living workshop that has been sponsored by a local seniors' center. The discussion has turned to the problem of heart failure, and the nurse is emphasizing preventative measures. When teaching older adults to decrease their future risks of developing heart failure, the nurse should emphasize what action?

Back 52

Hypertension is a major risk factor for heart failure. Inactivity, obesity, and hyperlipidemia are also risk factors, but they are statistically less significant than hypertension. Effective stress management is beneficial, but stress is not a major risk factor for heart failure.The correct answer is: Close blood pressure monitoring and vigilant adherence to hypertension therapy

Front 53

A critical care nurse is part of the code blue response team at the hospital and has been paged to the emergency department where a patient's condition has rapidly decompensated into ventricular fibrillation (VF). The nurse should prepare to assist with which of the following interventions?

Back 53

VF necessitates prompt defibrillation. Cardioversion is not possible, due to the absence of an identifiable rhythm. Metoprolol and digoxin are not priority treatments for VF.The correct answer is: Defibrillation

Front 54

A critical care nurse is providing care for a patient who was admitted to the intensive care unit after going into cardiogenic shock while on one of the hospital's medical units. This nurse should plan assessments and interventions in the knowledge that the effects of cardiogenic shock primarily result from:

Back 54

The classic signs of cardiogenic shock are those of tissue hypoperfusion and result from heart failure and the overall shock state rather than changes in osmosis of the ANS. Cardiac biomarkers are not toxic.The correct answer is: Tissue hypoperfusion

Front 55

A female patient who has been experiencing progressive syncope, dyspnea, and hypotension has been diagnosed with a third-degree atrioventricular (AV) block. The nurse should understand that the patient is experiencing these symptoms because:

Back 55

Third-degree AV block occurs when no atrial impulse is conducted through the AV node into the ventricles. A patient has a second-degree block when only some of the atrial impulses are conducted through the AV node into the ventricles. When the sinus node fails to create an impulse, the patient experiences an idioventricular rhythm. During a premature ventricular complex, an impulse starts in a ventricle and is conducted through the ventricles before the next normal sinus impulse.The correct answer is: Conduction of the electrical impulse is failing to progress beyond the atria to the ventricles.

Front 56

A group of new nurses are going to work on the telemetry unit. They are taking a class on electrocardiograms (ECGs) and arrhythmias. What would the staff educator tell this class about ST segments?

Back 56

The ST segment is the part of an ECG that reflects the end of the QRS complex to the beginning of the T wave. The part of an ECG that reflects repolarization of the ventricles is the T wave; the part of an ECG used to calculate ventricular rate and rhythm is the RR interval; the part of an ECG that reflects the time from ventricular depolarization through repolarization is the QT interval.The correct answer is: The part of an ECG that reflects the end of the QRS complex to the beginning of the T wave

Front 57

A man's recent history of fatigue and lightheadedness has just been attributed to a junctional arrhythmia. The nurse should anticipate which of the following characteristics of the man's electrocardiogram (ECG)?

Back 57

A junctional arrhythmia is characterized by a rate of 40 to 60, regular rhythm, and normal QRS duration. A P wave may or may not be present.The correct answer is: Rate of 40 to 60 beats per minute

Front 58

A nurse has asked the unit educator what happens when the amount of fluid in the pericardial sac increases. What should the educator tell the nurse?

Back 58

An increase in pericardial fluid raises the pressure within the pericardial sac and compresses the heart. This causes elevated pressure in all cardiac chambers, decreased venous return due to atrial compression, and an inability of the ventricles to distend and fill adequately. Excess fluid in the pericardial sac does not cause fluid to leak through, compress the lungs, or cause the sac to rupture.The correct answer is: It raises the pressure inside the pericardial sac, compressing the heart.

Front 59

A nurse has been providing care for an older adult patient who has a number of comorbid medical conditions. The nurse has been performing frequent assessment throughout the morning due to the patient's pallor, decreased level of consciousness, and unstable vital signs. During the nurse's most recent assessment, the patient has lost consciousness and the carotid pulse is not palpable. What is the nurse's priority action?

Back 59

Once loss of consciousness has been established, the resuscitation priority for the adult in most cases is placing a phone call to activate the code team or the emergency medical system (EMS). This should precede the initiation of CPR. Supplementary oxygen and further assessment are appropriate, but these would not be prioritized over calling a code.The correct answer is: Activating the hospital's code system

Front 60

A nurse has performed an assessment of a patient and subsequently administered the patient's scheduled dose of ramipril, an angiotensin-converting enzyme (ACE) inhibitor prescribed for the treatment of the patient's longstanding heart failure (HF). The nurse understands that this drug will aid in the treatment of the patient's disease by:

Back 60

ACE inhibitors alleviate heart failure symptoms by causing vasodilation and decreasing myocardial workload. They do not have a positive inotropic effect and do not reduce oxygen demand. As well, ACE inhibitors do not promote the excretion of fluids and sodium like diuretics do.The correct answer is: Causing vasodilation and decreasing the heart's workload

Front 61

A nurse in the cardiac critical care unit is assisting with pericardiocentesis for a patient who developed a pericardial effusion. Which of the following outcomes would suggest that the procedure has achieved the desired effect?

Back 61

Pericardial effusion is associated with a decrease in blood pressure. Pericardiocentesis relieves pressure on the heart, allowing it produce a normal blood pressure. A narrowing pulse pressure is an abnormal assessment finding. Arterial blood gases should normalize after pericardiocentesis, but these cannot be monitored as closely or frequently as blood pressure. The patient's heart rate may or may not increase after pericardiocentesis.The correct answer is: The patient's blood pressure increases

Front 62

A patient converts from normal sinus rhythm at 80 beats/min to atrial fibrillation with a ventricular response at 166 beats/min. Blood pressure is 162/74. Respiratory rate is 20/min with normal chest expansion and clear lungs bilaterally. IV heparin and Cardizem are given. The nurse caring for the patient understands that the primary goal of treatment is what?

Back 62

reatment for atrial fibrillation is to terminate the rhythm or to control ventricular rate. A rapid ventricular response reduces the time for ventricular filling, resulting in a smaller stroke volume. Control of rhythm is the initial treatment of choice followed by anticoagulation with heparin and then Coumadin.The correct answer is: Control ventricular rate

Front 63

A patient has a diagnosis of dilated cardiomyopathy (DCM) and was admitted 24 hours ago for treatment. Which of the following principles should the nurse integrate into the planning of this patient's care?

Back 63

For patients with cardiomyopathy, bed rest is maintained to decrease cardiac workload. Physical activity is increased slowly, and the patient is asked to report symptoms that occur with increasing activity. However, it is not normally necessary for the patient to avoid a heart rate of 75 or greater in the longer term.The correct answer is: The patient will benefit from bed rest in the short term, and activity should be introduced slowly.

Front 64

A patient has been admitted to the hospital with exacerbation of heart failure (HF) that has resulted in pulmonary and peripheral edema. The nurse has been carefully monitoring the trajectory of the patient's signs and symptoms of HF. How can the nurse best monitor the patient's fluid balance?

Back 64

Changes in fluid balance can be identified by monitoring the patient's weight on a daily basis. This assessment is more accurate than assessing skin turgor. Intake must be considered in combination with output. BUN and creatinine levels provide important data, but these do not convey the patient's fluid balance when considered in isolation.The correct answer is: By performing daily weights at the same time each day

Front 65

A patient has been admitted to the medical unit because of an exacerbation of heart failure. Over the past hour, the patient has become increasingly restless, tachypneic, and short of breath, and pulse oximetry reveals SaO2 of 78%. Which of the following actions should the nurse prioritize?

Back 65

Protecting a patient's airway and breathing is always a priority over further assessments and providing reassurance to a patient.The correct answer is: Protecting the patient's airway and taking measures to promote gas exchange

Front 66

A patient has been admitted to the unit for an electrophysiology (EP) study. For what is an electrophysiology study primarily performed?

Back 66

A patient may undergo an EP study in which electrodes are placed inside the heart to obtain an intracardiac electrocardiogram (ECG). This is used not only to diagnose the dysrhythmia, but also to determine the most effective treatment plan. However, because an EP study is invasive, it is performed in the hospital and may require that the patient be admitted. The primary purpose of an EP is not freezing hypersensitive cells, facilitating cardioversion, or determining the plan of nursing care.The correct answer is: To diagnose the dysrhythmia

Front 67

A patient has been admitted with endocarditis. The patient asks the nurse how the health care provider knows what medicines to order to kill the bacteria. The nurse knows that to find the most appropriate antibiotic treatment, what test would be the most helpful?

Back 67

To help determine the causative organisms and the most effective antibiotic treatment for the patient, blood cultures are taken. A CBC can help establish the degree and stage of infection. An echocardiogram or an ABG would not specify the causative organism.The correct answer is: Blood cultures

Front 68

A patient has been diagnosed with mitral valve prolapse (MVP) following an echocardiogram and will begin treatment imminently. When planning this patient's care, the nurse will prioritize:

Back 68

Patients with MVP are often asymptomatic, and treatment and nursing management are aimed at managing symptoms and preserving function. MVP does not predispose the patient to infection, pericardial effusion, or ischemic heart disease.The correct answer is: Preserving the patient's existing level of function

Front 69

A patient has been newly diagnosed with heart failure (HF) and has come to the meet with the nurse at the clinic for health education. What lifestyle recommendation should the nurse provide to this patient when discussing dietary modifications?

Back 69

Lifestyle recommendations for the management of HF include restriction of dietary sodium; avoidance of excessive fluid intake, alcohol, and smoking; weight reduction when indicated; and regular exercise. It is unnecessary to increase potassium intake, replace complex carbohydrates, or eat frequent, smaller meals.The correct answer is: “It's in your best interests to avoid excessive fluids and sodium in your diet.”

Front 70

A patient has been scheduled for cardioversion for treating a tachyarrhythmia that has not responded appreciably to pharmacologic treatment. In anticipation of this procedure, what patient education should the nurse provide?

Back 70

The patient's medication regimen is usually altered in anticipation of cardioversion. This often includes the use of anticoagulants for a few days before the procedure. Conscious sedation, rather than general anesthetic, is the preferred technique. Cardioversion is not normally followed by pain.The correct answer is: “Your health care provider will likely ask you to alter your normal medication routine before the procedure, so be sure to follow those instructions closely.”

Front 71

A patient has been scheduled for cardioversion in the treatment of a tachyarrhythmia but is unclear about the particulars of the procedure after signing the necessary informed consent. How can the nurse best explain this procedure to the patient?

Back 71

Cardioversion is used to treat tachyarrhythmias by delivering an electrical current that depolarizes a critical mass of myocardial cells. When the cells repolarize, the sinus node is usually able to recapture its role as the heart's pacemaker. The procedure does not destroy malfunctioning cells or “boost” the heart's electrical activity. As well, it does not replace any of the misfiring cells.The correct answer is: “Cardioversion will essentially 'reset' the cells in your heart that control the electrical activity.”

Front 72

A patient has been slated for cardiac conduction surgery. What would be the criteria for a patient to have this surgery?

Back 72

Cardiac conduction surgery is considered in patients with atrial tachycardias and ventricular tachycardias that do not respond to medications.The correct answer is: Atrial and ventricular tachycardias not responsive to other treatments

Front 73

A patient has developed pulmonary edema during an exacerbation of heart failure. The patient is experiencing dyspnea primarily because of the accumulation of pressure in the patient's:

Back 73

In the pathophysiology of pulmonary edema, the left ventricle cannot handle increased fluid volume. As a result, blood volume and pressure build up in the left atrium. This ultimately results in the accumulation of fluid in the patient's lungs.The correct answer is: Left atrium

Front 74

A patient has returned from the operating room after having a permanent pacemaker implantation. What potential complication should the nurse assess for most closely in a postoperative patient immediately following permanent pacemaker implantation?

Back 74

Bleeding, hematomas, local infections, perforation of the myocardium, and tachycardia are complications of pacemaker implantations. Low output, DVT, and decreased respirations are not implausible, but assessment of the implantation site would be prioritized in the immediate recovery period.The correct answer is: Bleeding at the implantation site

Front 75

A patient has returned to the cardiac care unit after undergoing cardioversion. When providing care for this patient during the immediate recovery period, the nurse should prioritize assessments related to:

Back 75

When the heart returns to a normal sinus rhythm after cardioversion, the atria beat forcefully. If a clot has formed in the atria, systemic emboli may result, thus anticoagulation is needed if the arrhythmia has lasted over 48 hours. The nurse is alert for systemic signs of embolization such as sudden onset shortness of breath with pulmonary emboli or neurological changes. Sensory changes, renal failure, and infection are unlikely complications of cardioversion.The correct answer is: Thromboembolism

Front 76

A patient is undergoing preoperative teaching before cardiac surgery. The nurse explains that a temporary pacemaker will be placed later that day, and it will be removed after the surgery. The patient asks the nurse what will happen if the pacemaker quits functioning. What is the nurse's best response?

Back 76

Monitoring for pacemaker malfunctioning and battery failure is a nursing responsibility.The correct answer is: “Monitoring for pacemaker malfunctioning and battery failure is something the nurse caring for you does.”

Front 77

A patient newly admitted to the telemetry unit is experiencing progressive fatigue, hemoptysis, and dyspnea as a result of pulmonary venous hypertension. What valvular disorder would cause pulmonary venous hypertension?

Back 77

The first symptom of mitral stenosis is often dyspnea on exertion as a result of pulmonary venous hypertension. Symptoms usually develop after the valve opening is reduced by one-third to one-half its usual size. Patients are likely to show progressive fatigue as a result of low cardiac output. The enlarged left atrium may create pressure on the left bronchial tree, resulting in a dry cough or wheezing. Patients may expectorate blood (ie, hemoptysis) or experience palpitations, orthopnea, paroxysmal nocturnal dyspnea (PND), and repeated respiratory infections. Pulmonary venous hypertension is not caused by aortic regurgitation, mitral valve prolapsed, or aortic stenosis.The correct answer is: Mitral stenosis

Front 78

A patient with a history of acute coronary syndrome is having an electrocardiogram (ECG). When interpreting the ECG for potential signs of cardiac ischemia, the nurse should focus on which of the following waveforms and intervals?

Back 78

ST segment changes are associated with ischemia and cardiac injury. A U wave is not always present, and the P wave represents atrial depolarization. The character of the QT interval is not a primary indicator of cardiac ischemia or injury.The correct answer is: ST segment

Front 79

A patient with a history of primary hypertension has undergone echocardiography after being referred to a specialist for blood pressure management. The patient's echocardiogram revealed ventricular hypertrophy and a decreased ejection fraction. The nurse who is providing care for this patient should recognize that these findings are characteristic of what valvular disorder?

Back 79

AS is narrowing of the valve opening between the left ventricle (LV) and the aorta, resulting in obstruction of blood flow across the valve. The LV overcomes this by contracting more slowly and more strongly than normal, forcibly squeezing the blood through the smaller orifice. This increases LV pressure, and the ventricular wall hypertrophies and dilates. Mitral stenosis, mitral regurgitation, and tricuspid regurgitation are not normally accompanied by LV hypertrophy.The correct answer is: Aortic stenosis (AS)

Front 80

A patient with a recent history of infective endocarditis has asked his nurse practitioner about the use of prophylactic antibiotics before getting his teeth cleaned at his dentist. The patient states that he read about such measures on a website. Which of the following guidelines will underlie the nurse's response to the patient?

Back 80

Recent changes to practice guidelines no longer specify antibiotic prophylaxis for lower-risk individuals.The correct answer is: Low-risk individuals are no longer required to receive antibiotic prophylaxis before dental work.

Front 81

A patient with dilated cardiomyopathy has been placed on the transplant list due to the severity of her symptoms and her poor prognosis. While waiting for a donor heart, which of the following interventions carries the greatest potential for reducing the workload on the patient's heart?

Back 81

VADs can support a failing heart by generating blood flow to the systemic circulation and unloading the ventricle. Valve replacement, percutaneous aortic balloon valvuloplasty, and angioplasty do not address the structural and functional cardiac deficits that characterize cardiomyopathy.The correct answer is: A ventricular assist device (VAD)

Front 82

A patient with mitral stenosis exhibits symptoms of a dysrhythmia. Based on the pathophysiology of this disease process, the nurse would expect the patient to exhibit what heart rhythm?

Back 82

In patients with mitral stenosis, the pulse is weak and often irregular because of atrial fibrillation (caused by the strain on the atrium). A low-pitched, rumbling, diastolic murmur is heard at the apex, caused by strain on the atrium. The patient experiences atrial dysrhythmias.The correct answer is: Atrial fibrillation

Front 83

A patient with pericarditis has been admitted to the CCU. The nurse caring for the patient knows that the most common clinical manifestation of pericarditis is what?

Back 83

The most characteristic symptom of pericarditis is chest pain, although pain also may be located beneath the clavicle, in the neck, or in the left trapezius (scapula) region. The pain or discomfort usually remains fairly constant, but it may worsen with deep inspiration and when lying down or turning.The correct answer is: Chest pain

Front 84

A patient's electrocardiogram (ECG), which has been ordered stat, indicates that the patient is experiencing ventricular tachycardia (VT). Which of the following nursing diagnoses should the nurse prioritize in the immediate care of this patient?

Back 84

A patient in VT is experiencing a medical emergency; decreased CO is the priority for intervention. Anxiety and knowledge deficit are valid diagnoses but would be superseded by the importance of promoting CO. Dysreflexia is not a relevant nursing diagnosis for this patient.The correct answer is: Cardiac output (CO), decreased

Front 85

After a detailed diagnostic workup, a patient has been diagnosed with atrial septal defect (ASD). The nurse should recognize that this patient may exhibit many of the signs and symptoms that are typically associated with:

Back 85

Because of left-to-right shunting of blood in ASDs, patients often experience elevated right heart pressure and pulmonary congestion. This does not mimic the signs and symptoms of acute coronary syndrome or of infectious processes such as endocarditis.The correct answer is: Right-sided heart failure

Front 86

An older adult patient with a recent history of syncope has undergone an initial diagnostic workup that has failed to identify the cause of his fainting. As a result, continuous electrocardiographic (ECG) monitoring (Holter monitoring) has been ordered. When initiating this diagnostic testing, what patient education should the nurse provide?

Back 86

During ambulatory ECG, the patient keeps a diary noting the type and time of symptoms or performance of unusual activities. It is unnecessary to avoid activity or electrical devices. It is unsafe and unnecessary to discontinue medications during Holter monitoring.The correct answer is: “Record your activities in your log so that they can be cross-referenced with your ECG readings.”

Front 87

Following several months of increasing dyspnea on exertion, a 71-year-old woman has been diagnosed with mitral stenosis (MS). The woman is relieved to receive a diagnosis that explains her symptoms but does not completely understand the root of her problem. How can the nurse best explain the woman's health problem?

Back 87

In MS, the valve orifice is narrowed and blood flow from the left atrium into the left ventricle (LV) is impaired. MS is not characterized by increased afterload or regurgitation. The mitral valve is between the left atrium and left ventricle, not between the heart and lungs.The correct answer is: “The valve in the left side of your heart has become stiff and narrowed, so your heart can't fill with all the blood that your body needs.”

Front 88

Recent exacerbation of a patient's mitral valve regurgitation prompted her cardiologist to perform a mitral valve replacement in which the patient received a mechanical valve. In the weeks following the patient's surgery, which of the following blood tests will be most relevant to the patient's potential complications?

Back 88

The disadvantage of mechanical heart valves is the need for anticoagulation, which is normally achieved through the daily administration of warfarin (Coumadin). This necessitates monitoring of the patient's INR. The patient's WBC, potassium, BUN, and creatinine levels are less likely to be affected by the presence of a mechanical valve.The correct answer is: International normalized ratio (INR)

Front 89

The cardiac monitor alarm alerts the critical care nurse that the patient is showing no cardiac rhythm on the monitor. When the nurse assesses the patient, the patient is found to be experiencing cardiac arrest. In providing cardiac resuscitation documentation, how will the nurse describe this initial absence of cardiac rhythm?

Back 89

Cardiac arrest occurs when the heart ceases to produce an effective pulse and circulate blood. It may be caused by a cardiac electrical event such as ventricular fibrillation, ventricular tachycardia, profound bradycardia, or when there is no heart rhythm at all (asystole). Cardiac arrest may also occur when electrical activity is present but there is ineffective cardiac contraction or circulating volume, which is PEA. Asystole is the only condition that involves the absence of a heart rhythm.The correct answer is: Asystole

Front 90

The emergency department nurse is caring for a patient who has gone into cardiac arrest. The nurse is performing external defibrillation. Which of the following is a vital step in the procedure?

Back 90

In external defibrillation, both paddles may be placed on the front of the chest, which is the standard paddle placement. Whether using pads or paddles, the nurse must observe two safety measures. First, maintain good contact between the pads or paddles and the patient's skin to prevent leaking. Second, ensure that no one is in contact with the patient or with anything that is touching the patient when the defibrillator is discharged, to minimize the chance that electrical current will be conducted to anyone other than the patient. Ventilation should be stopped during defibrillation.The correct answer is: No one is to be touching the patient at the time shock is delivered.

Front 91

The nurse has attended morning report on a busy medical unit. The nurse recognizes which patient to be at greatest risk for the development of cardiogenic shock?

Back 91

Cardiogenic shock may occur following a MI when a large area of myocardium becomes ischemic, necrotic, and hypokinetic. It also can occur as a result of end-stage heart failure, cardiac tamponade, pulmonary embolism, cardiomyopathy, and dysrhythmias. While patients with acute renal failure are at risk for dysrhythmias, and patients experiencing a stroke are at risk for thrombus formation, the patient admitted following an MI is at the greatest risk for development of cardiogenic shock when compared to the other diagnoses.The correct answer is: The patient admitted following a myocardial infarction (MI).

Front 92

The nurse has completed a head-to-toe assessment of a patient who was admitted for the treatment of heart failure (HF). Which of the following assessment findings should signal to the nurse a possible exacerbation of the patient's condition?

Back 92

Patients with HF often exhibit crackles, which are produced by the sudden opening of edematous small airways and alveoli that have adhered together by exudate. These may be heard at the end of inspiration and are not cleared with coughing. A widened pulse pressure, increased BP, and production of dilute urine are not characteristic of HF. Changes in blood glucose levels are not normally symptomatic of HF.The correct answer is: Crackles are audible on chest auscultation.

Front 93

The nurse has conducted a comprehensive assessment of a new resident of a long-term care facility. Which assessment data, collected by the nurse, indicate the most significant increase in a patient's risk for heart failure (HF)?

Back 93

HF is the most common reason for hospitalization of people older than 65 years of age and is the second most common reason for visits to a health care provider's office. A potassium level of 5.7 mEq/L does not indicate an increased risk for HF. The fact that the patient takes Lasix 20 mg/day does not indicate an increased risk for HF. The fact that a patient is an African American man does not indicate an increased risk for HF.The correct answer is: Age of 65 years or older

Front 94

The nurse has entered the room of a patient and found the patient diaphoretic, panicked, and clutching his chest. What action should the nurse first perform?

Back 94

An emergent cardiac event requires a prompt nursing response that should begin with an efficient assessment of the patient's condition (airway, breathing, circulation, and consciousness). The results of this rapid assessment provide the basis for nurse's decision to call a cardiac arrest code. This assessment is a priority over oxygen supplementation, reassurance, and repositioning, even though each of these measures may be appropriate.The correct answer is: Perform a rapid assessment of the patient.

Front 95

The nurse is admitting a patient to the cardiac care unit with complaints of dyspnea on exertion and fatigue. The patient's electrocardiogram (ECG) shows dysrhythmias associated with left ventricular hypertrophy. What diagnostic tool would be the most helpful in diagnosing cardiomyopathy?

Back 95

The echocardiogram is one of the most helpful diagnostic tools because the structure and function of the ventricles can be observed easily. ECG demonstrated dysrhythmias and changes consistent with left ventricular hypertrophy. A cardiac catheterization, ABGs, and Swan-Ganz analysis would not be helpful in diagnosing cardiomyopathy.The correct answer is: Echocardiogram

Front 96

The nurse is admitting a patient who is experiencing increased signs and symptoms of dilated cardiomyopathy (DCM). What changes in the heart characterize DCM?

Back 96

DCM is characterized by significant dilation of the ventricles without significant concomitant hypertrophy and systolic dysfunction.The correct answer is: Dilated ventricles without hypertrophy of the ventricles

Front 97

The nurse is analyzing a rhythm strip. What does the nurse look at to identify ventricular repolarization?

Back 97

The T wave represents ventricular muscle repolarization. The P wave, U wave, and QRS complex do not represent ventricular repolarization.The correct answer is: T wave

Front 98

The nurse is assessing for hepatojugular reflux in a patient with a history of heart failure. When performing this assessment, the nurse will:

Back 98

Hepatojugular reflux, a sign of right-sided heart failure, is assessed with the head of the bed at a 45-degree angle. As the right upper abdomen (the area over the liver) is compressed for 30 to 40 seconds, the nurse observes the internal jugular vein. If the internal jugular vein becomes distended, a patient has positive hepatojugular reflux.The correct answer is: Press the patient's right upper abdomen

Front 99

The nurse is caring for a patient with acute pericarditis. What nursing management would be instituted to minimize complications?

Back 99

To minimize complications, the nurse helps the patient with activity restrictions until the pain and fever subside. As the patient's condition improves, the nurse encourages gradual increases of activity. Actions to minimize complications of acute pericarditis do not include keeping the patient isolated; coughing and deep breathing are not encouraged. An increase in fluid intake is not necessarily required.The correct answer is: The nurse helps the patient with activity restrictions until the pain and fever subside.

Front 100

The nurse is conducting a morning assessment of an 80-year-old female patient who has a longstanding diagnosis of heart failure (HF). The nurse notes an elevation in jugular venous pressure (JVP) greater than 4 cm above the woman's sternal angle, a finding that did not exist the day before. What conclusion should the nurse draw from this assessment finding?

Back 100

Increased JVP is associated with right-sided HF. Dyspnea may or may not be present, but is more closely associated with left-sided HF. Increased JVP is not necessarily indicative of impending shock.The correct answer is: The woman may be experiencing an exacerbation of right-sided HF.

Front 101

The nurse is on the infection control committee of a hospital and is looking into three cases of hospital-acquired infective endocarditis. What classification of patient is at highest risk for hospital-acquired endocarditis?

Back 101

Hospital-acquired infective endocarditis occurs most often in patients with debilitating disease or indwelling catheters, and in patients who are receiving hemodialysis or prolonged IV fluid or antibiotic therapy. Patients taking immunosuppressive medications or corticosteroids are more susceptible to fungal endocarditis. Patients on immunoglobulins, those who need in-and-out catheterization and chemotherapy patients are not at increased risk for nosocomial infective endocarditis.The correct answer is: Hemodialysis patients

Front 102

The nurse is performing a comprehensive assessment of a new female resident of a long-term care facility. The nurse reads in the resident's accompanying documentation that she had rheumatic fever as a girl. The nurse should recognize that the resident has a significantly increased risk of developing:

Back 102

Rheumatic fever is a significant risk factor for valvular diseases such as mitral stenosis and mitral regurgitation. This disease is not closely associated with septal defects, pericarditis, or DCM.The correct answer is: Mitral stenosis

Front 103

The nurse is performing a physical assessment on a patient suspected of being in heart failure. During auscultation, heart failure would be suggested by:

Back 103

The heart is auscultated for an S3 heart sound, a sign that the heart is beginning to fail and that increased blood volume fills the ventricle with each beat. Crackles and wheezing may be heard in a patient with heart failure but do not indicate that the heart is beginning to fail. An S4 heart sound may or may not be present, although it is also consistent with heart failure.The correct answer is: An S3 heart sound

Front 104

The nurse is providing care for a patient newly diagnosed with systolic heart failure (HF). What medications should the nurse anticipate administering?

Back 104

Several medications are routinely prescribed for systolic HF, including angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, diuretics, and digitalis. Calcium channel blockers and alpha agonists are not routinely ordered for systolic HF. Angiotensin prohibiters are a distracter for this question.The correct answer is: Beta-blockers

Front 105

The nurse is providing discharge teaching to a patient diagnosed with heart failure. What should the nurse teach this patient to do to monitor fluid balance?

Back 105

Daily weights at the same time every day can be a good indicator of fluid balance. Assessing radial pulses and monitoring the blood pressure may be done, but they do not provide information about fluid balance.The correct answer is: Monitor weight daily.

Front 106

The nurse is teaching a patient diagnosed with aortic stenosis the importance of attempting to relieve the symptom of angina without drugs. What should the nurse teach the patient?

Back 106

The venous dilation that results from nitroglycerin decreases blood return to the heart, thus decreasing cardiac output and increasing the risk of syncope and decreased coronary artery blood flow. The nurse teaches the patient about the importance of attempting to relieve the symptoms of angina with rest and relaxation before taking nitroglycerin and to anticipate the potential adverse effects.The correct answer is: To rest and relax before taking nitroglycerin

Front 107

The nurse recognizes that an older adult patient with heart failure is experiencing the effects of inadequate cardiac output, a problem that affects many of the body's systems. Inadequate perfusion of the patient's kidneys leads to which of the following pathophysiological effects?

Back 107

A decrease in renal perfusion due to low CO and vasoconstriction then causes the release of renin by the kidney. Renin promotes the formation of angiotensin I, a benign, inactive substance. Angiotensin-converting enzyme (ACE) in the lumen of pulmonary blood vessels converts angiotensin I to angiotensin II, a potent vasoconstrictor, which then increases the blood pressure and afterload. Decreased CO does not directly cause acid–base imbalances, electrolyte imbalances, or decreased erythropoiesis.The correct answer is: Increased renin release

Front 108

The nurse who is caring for a patient suspected of having pericarditis is aware that the patient's chest pain must be clearly differentiated from chest pain that may be attributable to myocardial infarction. When assessing the patient, how should the nurse make this differentiation?

Back 108

Recognizing that deep inspiration or coughing intensifies pain may help to differentiate the pain of pericarditis from the pain of myocardial infarction. The onset, character, and effect of positioning are less likely to help the clinician determine the etiology of the patient's pain.The correct answer is: “When you breathe in deeply, does your pain get more intense?”

Front 109

The staff educator is presenting a workshop on valvular disorders. When discussing the pathophysiology of aortic regurgitation, the educator emphasizes that aortic regurgitation causes what?

Back 109

Aortic regurgitation eventually causes left ventricular hypertrophy. In aortic regurgitation, blood from the aorta returns to the left ventricle during diastole in addition to the blood normally delivered by the left atrium. The left ventricle dilates, trying to accommodate the increased volume of blood. Aortic regurgitation does not cause cardiac tamponade, right-sided heart failure, or ventricular insufficiency.The correct answer is: Left ventricular hypertrophy

Front 110

The staff educator is teaching a CPR class. What is an important aspect of defibrillating that the educator stresses to their class?

Back 110

Use multifunction conductor pads or paddles with a conducting medium between the paddles and the skin (the conducting medium is available as a sheet, gel, or paste). Do not use gels or pastes with poor electrical conductivity.The correct answer is: Use a conducting medium between the multifunction paddles and the skin.

Front 111

When assessing the patient with pericardial effusion, the nurse will assess for pulsus paradoxus. Pulsus paradoxus is characterized by:

Back 111

Systolic blood pressure that is markedly lower during inhalation is called pulsus paradoxus. The difference in systolic pressure between the point that is heard during exhalation and the point that is heard during inhalation is measured. Pulsus paradoxus exceeding 10 mm Hg is abnormal.The correct answer is: A systolic blood pressure that is lower during inhalation.

Front 112

While teaching a CPR class, a student in the class asks what the difference is between cardioversion and defibrillation. What would be the nurse's best response?

Back 112

One major difference between cardioversion and defibrillation is the timing of the delivery of electrical current. In cardioversion, the delivery of the electrical current is synchronized with the patient's electrical events; in defibrillation, the delivery of the current is immediate and unsynchronized.The correct answer is: “The difference is the timing of the delivery of the electric current.”