Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
42 Cards in this Set
- Front
- Back
|
____ is the ability of cardiac cells to generate an electrical pulse spontaneously and repetitively
a. Excitability b. Automaticity c. Contractility d. Conductivity |
B. Automaticity – it is the ability to generate an electrical pulse spontaneously and repetitively
Excitability is the ability to respond to an electrical impulse Contractility is the mechanical activity of the heart Conductivity is the ability to transmit an electrical stimulus from one cell membrane to another |
|
|
A nurse is caring for a patient admitted for hypotension, dizziness, weakness, and syncope. The patient’s vital signs are; BP=76/54, P=50, R=22, T=98.0. Which of the following drugs should the nurse administer to the patient?
a. Amiodarone b. Amlodipine c. Atropine d. Digoxin |
C. Atropine
In sinus bradycardia, sinus mode discharge rate is less than 60 beats per min. Syncope, hypotension, weakness, and dizziness is common and if the patient is experiencing any of these symptoms and the underlying cause isn’t determined, treatment of choice is atropine to increase the heart rate to about 60 beats/min. |
|
|
A nurse in the telemetry unit is caring for a patient with bradycardia. The patient was given atropine 0.5mg IV bolus. Which of the following is a side effect of the drug and requires proper nursing intervention?
a. Dry mouth b. Nagging cough c. Excessive bleeding d. Nausea |
A. Dry mouth
Atropine is an anticholinergic drug. Assess for urinary retention and dry mouth after administration |
|
|
A patient was admitted for fatigue, weakness, SOB, and palpitations. Patient’s medical history includes diabetes, hypertension, and CHF. The patient’s EKG reading shows disorganized rhythm with no distinguishable P waves. The patient’s condition is most likely:
a. Atrial flutter b. Atrial fibrillation c. Ventricular fibrillation d. Sinus tachycardia |
B. Atrial fibrillation
In patients with A-fib, multiple rapid impulses depolarize the atria in a totally disorganized manner. The result is a chaotic rhythm with no clear P waves, no atrial contractions, loss of atrial kick, and an irregular ventricular response |
|
|
A patient was admitted for fatigue, weakness, SOB, and palpitations. Patient’s medical history includes diabetes, hypertension, and CHF. The patient’s EKG reading shows disorganized rhythm with no distinguishable P waves. The patient was diagnosed with Atrial fibrillation, which of the following drugs should the nurse anticipate to administer?
a. Amiodarone b. Atropine c. Epinephrine d. Furosemide |
A. Amiodarone
Traditional interventions for A-fib include calcium channel blockers (diltiazem, amiodarone), and anticoagulants (heparin, coumadin) |
|
|
A patient diagnosed with an A-fib is scheduled to have a cardioversion procedure. The nurse is performing patient teaching about the procedure. Which of the following drugs would the nurse anticipate the patient to take regarding the procedure?
a. Diuretic b. ACE inhibitor c. NSAID d. Anticoagulant |
D. Anticoagulant
Before elective cardioversion, the healthcare provider prescribes an anticoagulation therapy for about 6 weeks to prevent a thrombo-embolic event if the rhythm is successfully converted |
|
|
A patient who had a cardioversion procedure in the morning was admitted to the telemetry unit for further observation. The patient reported “feeling very anxious” and complains of chest pain, SOB, and has coughed up blood-tinged sputum. Which of the following interventions should the nurse do?
a. Administer IV amiodarone b. Give oxygen c. Obtain sputum culture for the lab d. Administer low dose morphine PRN |
B. Give oxygen
The patient might be experiencing a pulmonary embolism. Give supplemental oxygen. The physician should be notified immediately and the patient further assessed for changes in mental status, speech, and sensory and motor function. Take vital signs, assess strength and quality of pulses, urine output, back pain, and check for reports of GI disturbances. |
|
|
A patient diagnosed with an A-fib is scheduled to have a cardioversion procedure. The healthcare team is performing patient teaching about the procedure. Which of the following patient statement would need further teaching by the healthcare team?
a. “I will take an anticoagulant medication 4 – 6 weeks before the procedure” b. “I will not receive supplemental oxygen during the procedure” c. “I need to sign a consent form before going in” d. “I can continue taking Digoxin to help prevent complications of A-fib” |
D. “I can continue taking Digoxin to help prevent complications of A-fib”
Digoxin increases ventricular irritability and puts patient at risk for VF after the countershock. The drug is withheld for up to 48 hours before the procedure. For safety, the oxygen device has to be removed and turned away from the patient. Oxygen supports combustion, and a fire may result if shock is delivered |
|
|
A patient was admitted for fatigue, weakness, SOB, and palpitations. Patient’s medical history includes diabetes, hypertension, and CHF. The patient’s EKG reading shows disorganized rhythm with no distinguishable P waves. The patient was diagnosed with Atrial fibrillation and is put on IV digoxin. Which of the following should be closely monitored for the patient regarding the drug? [select all that apply]
a. WBC count b. Hemoglobin c. Hematocrit d. Serum potassium level e. Serum creatinine level |
D. Serum potassium level
E. Serum creatinine level Hypokalemia increases the risk of toxicity and ventricular dysrhythmias. Impaired renal function can cause toxicity |
|
|
A nurse is caring for a patient in the cardiac/telemetry unit. She is about to administer AM medications to the patient (Lasix 40mg, and a maintenance dose of digoxin 0.5mg). Before administering the medications, the nurse checked the patient’s potassium level (3.6 mEq/L), apical pulse (70 beats/min), and serum digoxin level (within normal limits). Which of the following would indicate the need to withhold the medication?
a. Patient’s serum potassium level b. Patient’s apical pulse rate c. Dosage ordered for Lasix d. Dosage ordered for digoxin |
D. Dosage ordered for digoxin
The dosage ordered was twice the highest maintenance dose required for digoxin (0.125 – 0.25 mg) and administering that dosage would cause drug toxicity |
|
|
A nurse is doing an assessment on a patient in the cardiac/telemetry unit. Which of the following assessment findings would indicate a possible right-sided heart failure?
a. Crackles in the lungs b. Productive cough c. Swelling in the lower leg d. Weak peripheral pulses |
C. Swelling in the lower leg
Right-sided heart failure is characterized by circulatory congestion such as jugular vein distention, edema in the extremities, and ascites Left-sided heart failure is characterized by weak peripheral pulses, crackles, and productive cough |
|
|
A nurse in the emergency department is doing an assessment on an older adult patient. Which of the following patient statements would indicate a specific risk factor for heart failure in the older adult patient?
a. “My father and my grandmother both had hypertension” b. “I take ibuprofen for my arthritis” c. “My normal blood pressure is usually higher than my sister's” d. “I’ve had diabetes since I was 10 years old” |
B. “I take ibuprofen for my arthritis”
Older adults who take NSAIDs such as ibuprofen long-term can cause fluid and sodium retention which is a specific risk factor for heart failure in older adults |
|
|
A nurse in the emergency department is doing an assessment on an older adult patient. Which of the following interventions should the nurse perform to assess for left-sided heart failure?
a. Ask patient about weight gain b. Observe for presence of ascites c. Assess for edema in the extremities d. Ask if patient can perform normal ADLs without fatigue or dyspnea |
D. Ask if patient can perform normal ADLs without fatigue or dyspnea
With left-sided heart failure, cardiac output is diminished, leading to impaired tissue perfusion, and unusual fatigue. Many patients experience weakness or fatigue with activity or having a feeling of heaviness in their arms or legs |
|
|
A nurse in the cardiac/telemetry department is doing an assessment on a patient diagnosed with heart failure. Which of the following interventions should the nurse perform to best assess for complications of right-sided heart failure?
a. Monitor weight b. Assess and observe for edema in the extremities c. Observe / monitor sputum consistency d. Assess lungs for any crackles / wheezing |
A. Monitor weight
In ambulatory patients, edema is in the ankles and legs. When patients are restricted to bedrest, edema accumulates in the sacrum. Edema is an extremely unreliable sign of HF, and therefore accurate daily weights are needed to document fluid retention. Weight is the most reliable indicator of fluid gain or loss |
|
|
Which of the following tests would best diagnose heart failure?
a. MUGA b. Echocardiogram c. BNP d. BUN / creatinine |
B. Echocardiogram
Echocardiography is considered the best tool in diagnosing heart failure. Cardiac valvular changes, pericardial effusion, chamber enlargement, and ventricular hypertrophy can be diagnosed using this non-invasive technique. It can also be used to determine ejection fraction |
|
|
A nurse is assessing a patient with heart failure. The lung sounds commonly associated with heart failure are:
a. Bronchial b. Coarse crackles c. Fine crackles d. Friction rubs |
C. Fine crackles
Fine crackles are caused by fluid in the alveoli and commonly occur in patients with heart failure. Coarse crackles are typically caused by secretion accumulated in the airways. Friction rub occurs with pleural inflammation |
|
|
Which of the following drugs reduce cardiac preload in patients with heart failure?
a. Enalapril (vasotec) b. Furosemide (lasix) c. Digoxin (lanoxin) d. Dobutamine (dobutrex) |
B. Furosemide (lasix)
Ventricular fibers contract less forcefully when they are overstretched, such as in heart failure. Diuretics enhance renal excretion of sodium and water by reducing circulating blood volume, decreasing preload, and reducing systemic and pulmonary congestion |
|
|
A patient with acute HF complains of chronic dyspnea. Which of the following type of drugs would the nurse anticipate to administer to the patient?
a. Beta blocker b. Human B-type natriuretic peptide c. Nitrate d. Diuretic |
C. Nitrate
For patients with HF who experiences persistent dyspnea, a venous vasodilator (e.g. nitrate) may be prescribed. These drugs help by decreasing the volume of blood returning to the heart, and returning venous vasculature to a more normal capacity |
|
|
A patient with HF complains of having a headache soon after taking his Nitrate medication. The nurse taking care of the patient would administer which of the following drugs?
a. Digoxin b. Acetaminophen c. Furosemide d. Aspirin |
B. Acetaminophen
Patients taking Nitrates for HF may initially report headache. Acetaminophen (Tylenol) can be given to help relieve discomfort |
|
|
Which of the following assessment findings would indicate dehydration in an older adult patient taking a loop diuretic? [select all that apply]
a. Acute confusion b. Increased urinary output c. Decreased urinary output d. Shortness of breath e. Edema |
A. Acute confusion
C. decreased urinary output Loop diuretics continue to work even after excess fluid is removed. As a result some patients, especially older adults, can become dehydrated. Observe for manifestations of dehydration in the older adult, especially acute confusion and decreased urinary output |
|
|
A patient was admitted in the ICU for signs and symptoms of pulmonary edema. Initial assessment findings by the nurse include fine crackles at both bases of the lungs, disorientation, productive cough with pink-tinged sputum, and dyspnea. Which of the following should the nurse do first?
a. Continue with the assessment b. Administer 2L oxygen via nasal cannula c. Position the patient in supine position w/patient’s legs elevated d. Administer high-flow oxygen at 5 – 6L by facemask |
D. Administer high-flow oxygen at 5 – 6L by facemask
For pulmonary edema, the priority nursing action is to administer high-flow oxygen therapy at 5 – 6L/min by facemask or at 10 – 15L/min by non-rebreather mask with reservoir. |
|
|
An older adult patient diagnosed with atrial fibrillation is transferred to the cardiac / telemetry unit due to a signs and symptoms of HF. Which of the following tests should the nurse order in addition to the other routine tests?
a. TSH (thyroid stimulating hormone) levels b. GFR (Glomerular filtration rate) c. PFT (Pulmonary function tests) d. HA1C (Hemoglobin A1C) |
A. TSH (thyroid stimulating hormone) levels
Thyroxine (T4) and thyroid-stimulating hormone (TSH) levels should be determined in patients who are older than 65 years, have A-fib, or have evidence of thyroid disease. HF may be caused or aggravated by hypothyroidism or hyperthyroidism |
|
|
A nurse is doing an admission assessment on a patient with atherosclerosis. The patient’s blood pressure was 160/100, what should the nurse do next?
a. Assess BP on the other arm b. Call physician and request an order for antihypertensive medication c. Place the crash cart close by and continue on with the assessment d. Ask the patient about recent activities |
A. Assess BP on the other arm
Because of high incidence of hypertension in patients with atherosclerosis, blood pressure should be assessed on both arms. Perform a complete cardiovascular assessment because associated heart disease is often present |
|
|
Which of the following lab values indicate presence of atherosclerosis in a diabetic patient?
a. LDL-C level = 90 mg/dL b. HDL-C level = 60 mg/dL c. Total serum cholesterol level = 190 mg/dL d. Triglyceride level = 100 mg/dL |
A. LDL-C level = 90 mg/dL
Desirable LDL-C level for healthy people = below 100 mg/dL Desirable LDL-C level for people with CVD or diabetes = below 70 mg/dL Desirable HDL-C level is 40 mg/dL or greater Total serum levels should be below 200 mg/dL Triglyceride levels should be below 150 mg/dL |
|
|
Which of the following interventions is the most preferred method in controlling complications of atherosclerosis?
a. Prescribed HMG-CoA reductase inhibitor drugs (statins) b. Arterial revascularization c. Nutrition / lifestyle changes d. Anti-platelet agents |
C. Nutrition / lifestyle changes
Interventions for patients with atherosclerosis or those at high risk for the disease focus on lifestyle changes. Nutrition is one of the most important parts of the risk-reduction plan. If lipoprotein levels don’t improve after lifestyle changes, the healthcare provider may prescribe drug therapy to lower cholesterol and/or triglycerides |
|
|
A patient complains of recent muscle cramps, weakness and abdominal pain after taking her medication Simvastatin (Zocor). Recent lab work results show elevated liver enzyme levels. Which of the following should the nurse anticipate to do?
a. Decrease the dose of the drug b. Increase the dose of the drug c. Withhold the drug d. Nothing, as those symptoms are expected effects of the drug |
C. Withhold the drug
Statins (e.g. Simvastatin) are contraindicated in patients with active liver disease or during pregnancy because they can cause muscle myopathies, and marked decrease in liver function. Statin drugs are D/C’ed if the patient has muscle cramping or elevated liver enzymes |
|
|
A nurse is teaching a patient about maintaining a healthy heart. The nurse should include which point in her teaching?
a. Use alcohol in moderation b. Smoke in moderation c. Consume diet high in saturated fats and low in cholesterol d. Exercise 1 – 2 times per week |
A. Use alcohol in moderation
The nurse should advise the patient that alcohol may be used in moderation as long as there are no other contraindications for its use. Smoking, a diet high in saturated fats, and a sedentary lifestyle are all risk factors for cardiac disease. The patient should be encouraged to quit smoking, exercise 3 – 4 times per week, and consume a diet low in saturated fats and cholesterol |
|
|
An adult person with a BP of 120/80 is in which blood pressure classification?
a. Normal b. Prehypertension c. Stage 1 hypertension d. Stage 2 hypertension |
B. Prehypertension
The new classification for “normal” adult blood pressure is less than 120 mmHg systolic and less than 80 mmHg diastolic. Adults w/ BP of 120 – 139 mmHg systolic or 80 – 99 mmHg diastolic, considered “normal” under previous guidelines, are now classified as pre-hypertensive. Stage 1: 140/90 – 159/99, stage 2: 160/100 or greater |
|
|
Which of the following patients is at highest risk for developing primary hypertension?
a. 50 year old man with a suspected brain tumor and renal disease b. 30 year old woman who uses estrogen-containing oral contraceptives c. 50 year old woman with Cushing’s disease d. 70 year old man with family history of hypertension |
D. 70 year old man with family history of hypertension
A family history of hypertension is a major risk factor for developing primary hypertension |
|
|
Which of the following causes of secondary hypertension is manifested on a patient who has elevated blood pressure in the arms w/ normal or low BP in the lower extremities, and delayed or absent femoral pulses?
a. Coarctation of the aorta b. Pheochromocytoma c. Renal vascular disease d. Primary aldosteronism |
A. Coarctation of the aorta
Coarctation of the aorta is evidenced by elevated blood pressure in the arms w/ normal or low BP in the lower extremities, and delayed or absent femoral pulses. Presence of abdominal bruits is typical of patients with renal vascular disease Tachycardia, sweating, and pallor may suggest pheochromocytoma |
|
|
A patient with hypertension is complaining of a nagging cough and muscle weakness. The patient is currently taking an ACE inhibitor as part of his hypertension drug therapy. The nurse plans to replace the ACE inhibitors with a different drug. Which drug would the nurse choose?
a. Amlodipine (norvasc) b. Candesartan (atacand) c. Metoprolol (lopressor) d. Eplerenone (inspra) |
B. Candesartan (atacand)
Angiotensin II receptor blockers (ARBs) are excellent options for patients who report a nagging cough associated with ACE inhibitors and for those with hyperkalemia. Examples of ARB drugs are candesartan (atacand) and losartan (cozaar) |
|
|
Patients who experience muscle pain, cramping, or burning while exercising but relieved with rest is in what stage of peripheral arterial disease?
a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 |
B. Stage 2
Patients with stage 2 PAD experience intermittent claudication. Usually they can walk only a certain distance before a cramping, burning muscle discomfort or pain forces them to stop. The pain stops at rest. Symptoms are reproducible with exercise |
|
|
Which of the following is not considered a factor of thrombus formation?
a. Interrupted blood flow b. Endothelial injury c. Increased cardiac output d. Hypercoagulability |
C. Increased cardiac output
Thrombus formation has been associated with stasis of blood flow, endothelial injury, and hypercoagulability, known as Virchow’s triad |
|
|
A nurse is tasked to do an assessment on a patient who is at a high risk for developing DVT. All of the following accurately confirm the presence of DVT except:
a. Pain and tenderness and sudden onset of unilateral swelling of the leg b. Positive Homan’s sign (calf pain upon dorsiflexion of foot) c. Induration (hardening) of the blood vessel d. Redness, warmth, and edema |
B. Positive Homan’s sign (calf pain upon dorsiflexion of foot)
Pain in the calf upon dorsiflexion of the foot (positive Homan’s sign) appears in only a small percentage of patients with DVT, and false-positive findings are common. Therefore, checking a Homan’s sign isn’t advised |
|
|
To confirm a diagnosis of DVT on a patient, the nurse would anticipate an order for what specific blood test?
a. CKMB b. Troponin c. D-dimer d. CBC |
C. D-dimer
The D-dimer test is a global marker of coagulation activation and measures fibrin degradation products produced from clot breakdown. The test is used for diagnosis of DVT |
|
|
Which of the following types of drugs is the drug of choice to treat DVT?
a. Diuretics b. Anticoagulants c. Beta-blockers d. HMG-CoA |
B. Anticoagulants
Anticoagulants are the drugs of choice for actual DVT and for patients at risk for DVT. Conventional treatment has been IV unfractionated heparin followed by oral anticoagulation with warfarin (Coumadin) |
|
|
A nurse administered heparin to a patient. Which diagnostic lab test would the nurse closely monitor regarding the drug?
a. Activated partial thromboplastin time (aPTT) b. Prothrombin time – International normalized ratio (PT-INR) c. BUN creatinine d. Troponin |
A. Activated partial thromboplastin time (aPTT)
aPTT is monitored for patients receiving heparin therapy. It is measured at least daily and results are reported as soon as possible to allow adjustment of heparin dosage. Therapeutic aPTT levels are usually 1 ½ to 2 times normal control levels |
|
|
A patient who is on heparin therapy complains to the nurse of abdominal pain and blood-tinged urine. The patient also has an elevated pulse and decreased blood pressure. Which of the following drugs would the nurse anticipate to administer to the patient?
a. Vitamin K b. Activated charcoal c. Protamine Sulfate d. Aspirin |
C. Protamine Sulfate
The patient is showing signs and symptoms of bleeding. Protamine Sulfate is the antidote specifically for heparin. |
|
|
A nurse is doing a patient teaching procedure to a patient about SubQ anticoagulation therapy. Which patient statement indicates the need for further teaching?
a. “I will use an electric razor when shaving” b. “I will apply pressure and massage the injection site to increase drug absorption” c. “I can elevate my legs when I’m sitting in the chair” d. “oral contraceptives should be avoided” |
B. “I will apply pressure and massage the injection site to increase drug absorption”
Massaging the area should be avoided to prevent bruising Supportive therapies for DVT include bed rest and elevation of extremity. Teach patient to elevate his/her legs when on the bed or chair. |
|
|
A nurse administered coumadin to a patient. Which diagnostic lab test would the nurse closely monitor regarding the drug?
a. Activated partial thromboplastin time (aPTT) b. Prothrombin time – International normalized ratio (PT-INR) c. BUN creatinine d. Troponin |
B. PT-INR is monitored for patients receiving coumadin
PT levels should be 1.5 – 2 times the control value in seconds and the INR value should be 2 – 3 |
|
|
The nurse is performing patient teaching regarding the drug warfarin (Coumadin) and foods that contain vitamin K. Which foods should the nurse tell the patient to avoid?
a. Red meat b. Peanuts c. Green leafy vegetables d. Grapefruits |
C. Green leafy vegetables
Green leafy vegetables such as spinach, broccoli, and brussel sprouts are high in vitamin K |
|
|
The nurse is taking care of a patient on continuous IV heparin therapy. The patient’s aPTT results are: aPTT 100 seconds, control 35 seconds. Which intervention should the nurse anticipate?
a. Decrease the infusion rate b. Increase the infusion rate c. Continue the same infusion rate d. Stop the infusion |
A. Decrease the infusion rate
The therapeutic range of the aPTT should be 1.5-2 times greater than the control. The patient’s aPTT level is high and continuing the current rate could initiate bleeding. The infusion rate should be decreased, according to the prescribed protocol, until the APTT results have decreased. |
