cardiovascular exam 244

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Conduct a nursing assessment of the vascular and lymphatic systems.

left atrium

The _____ follows depolarization of the myocardium and represents a period during which no new cardiac potential can be propagated.

refractory period

Most cases of combined systolic and diastolic hypertension have no known cause and are therefore diagnosed as _____ hypertension.

primary

A patient is diagnosed with pulmonary disease and elevated pulmonary vascular resistance. Which of the following heart failures is most likely to develop from this condition?

right heart failure

A patient is receiving a drug that decreases peripheral arterial resistance. The nurse anticipates that the effect of this drug on the patient's cardiac function will result in

a decrease in afterload

A patient with a myocardial infarction has rhythm disturbances involving the AV node. The nurse recognizes that the coronary artery most likely occluded is the

right coronary artery

The nurse teaches a patient who is taking metoprolol (Topral) for treatment of hypertension to change position slowly because this drug

blocks the normal sympathetic nervous system response of vasoconstriction and increased heart rate with position changes

The nurse hears a very faint murmur in the S1 heart sound in a patient with a stenosed mitral valve. The nurse records the murmur as a

I/VI systolic murmur

A patient being treated with lisinopril (Zestril, Prinivil) asks the nurse how the drug lowers the blood pressure. The nurse explains that this drug

inhibits the effects of a substance in the blood that causes vasoconstriction and sodium and water retention

A patient with a blood pressure of 210/142 is admitted to the ICU with a diagnosis of hypertensive crisis. Clinical manifestations that the nurse would expect to find upon assessment include

headache, seizures, confusion, stupor, and coma

When teaching a patient with coronary artery disease about the disease's relationship to elevated serum lipid levels, the nurse explains that

each stage in the development of atherosclerotic lesions involves the presence and effects of fat substances in the blood

When obtaining a health history from a patient with newly diagnosed coronary artery disease, the nurse recognizes that a modifiable major risk factor for coronary artery disease is present in the patient's history of

obesity

During assessment of a patient with chest pain, the nurse recognizes that chest pain associated with unstable angina is

often unpredictable and may occur even at rest

A 42-year-old businesswoman has hypertension for which she rarely takes her prescribed medication. She is socially active and usually has several cocktails each evening and smokes a pack of cigarettes daily. In teaching the patient about her risk factors, the nurse stresses that the factor that has been identified as the most powerful contributor to coronary artery disease in women her age is

smoking

A diagnosis of acute coronary syndrome is the admission diagnosis for a patient transferred to the CCU. The nurse knows that this diagnosis indicates that the patient has experienced

unstable angina or a myocardial infarction

The nurse administers IV nitroglycerin to a patient with a myocardial infarction. In evaluating the effect of this intervention, the nurse recognizes that an expected outcome of the administration of the drug is

relief of pain

Three days after a myocardial infarction, the patient develops chest pain that radiates to the back and left arm and is relieved by sitting in a forward position. On auscultation of the patient's chest, the nurse would expect to hear

a pericardial friction rub

A 78-year-old man is brought by his family to the emergency department because he developed severe weakness and difficulty breathing at home. During assessment of the patient's cardiovascular status, the nurse is aware that coronary artery disease in patients this age

often manifests without the usual chest pain and diaphoresis characteristic of myocardial ischemia

While a patient who survived a sudden cardiac death with a preceding MI is recovering in the hospital, the nurse would expect diagnostic evaluation and treatment to focus on

presence and prevention of coronary occlusion

In preparing a patient for discharge from the hospital following a myocardial infarction, the nurse determines that further instruction is needed when the patient says

"My heart will be as good as new when I finish a cardiac rehabilitation program."

During early assessment of the patient with a myocardial infarction, the nurse is aware that the most important diagnostic test to determine the extent of an MI is

serial ECGs

During the hospitalization of a patient with a myocardial infarction, the nurse plans to start patient and family teaching about the disorder

while the patient is in the CCU

A patient with chronic congestive heart failure tells the nurse at the clinic that he has gained 5 pounds in the last 3 days, even though he has continued to follow a low-sodium diet. The nurse recognizes the patient

should be assessed for other symptoms that would indicate an exacerbation of congestive heart failure

The nurse monitors a patient receiving IV furosemide (Lasix) and enalapril (Vasotec) 5 mg po bid for an acute exacerbation of left sided congestive heart failure. The nurse determines that the treatment is effective upon finding

fewer crackles upon lung auscultation

A patient with acute congestive heart failure has severe dyspnea and is extremely anxious. The nurse anticipates that increased cardiac output and decreased anxiety may be promoted by the intravenous administration of

morphine

A patient admitted to the hospital with an exacerbation of her chronic congestive heart failure tells the nurse she was fine when she went to bed but woke up feeling as if she were suffocating. The nurse explains that the onset of these symptoms in the middle of the night is not unusual because

lying down promotes fluid reabsorption from her legs and when it returns to the heart, it is too much for the heart to pump out

The nurse closely monitors the fluid balance of a patient in congestive heart failure, with the knowledge that additional sodium and water retention occur in an already congested vascular system as a result of

decreased glomerular blood flow in the kidney

After successful digitalization, a patient is to begin oral maintenance of digoxin (Lanoxin) and furosemide (Lasix) for control of congestive heart failure. To prevent digitalis toxicity, the nurse understands that it is most important to monitor the patient's

serum potassium

While the nurse is taking a health history from a patient with hypertrophic cardiomyopathy, information that the nurse recognizes as significant includes

a family history of cardiomyopathy

A patient has a sinus arrest with a junctional escape rhythm. The nurse would expect the patient to have a pulse rate of

<40bpm

The nurse obtains a monitor strip on a patient admitted to the coronary care unit with a myocardial infarction and makes the following analysis: P wave not apparent; ventricular rate 142, R-R interval regular; PR interval not measurable; and QRS complex wide and distorted, >0.14 sec. The nurse interprets the patient's cardiac rhythm as

ventricular tachcardia

The cardiac monitor alarms on a patient being monitored in the coronary care unit, and the nurse notes a cardiac pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious with no pulse or respirations. After calling for assistance, the nurse should

start basic CPR

A patient in ventricular fibrillation is successfully resuscitated and regains consciousness. She asks the nurse about what happened to her. The most appropriate response by the nurse is

"You had some a serious abnormal cardiac rythym and function, which treatment was able to reverse."

A patient has received instruction on the management of her permanent pacemaker before discharge from the hospital. The nurse recognizes that teaching has been effective when the patient tells the nurse

I should take my pulse every day

A patient with supraventricular tachycardia is to receive cardioversion. The nurse knows that when cardioversion is used

the patient should be sedated before the procedure, if possible

While obtaining a nursing history from a 23-year-old man with rheumatic fever, the nurse recognizes that the most significant information relayed by the patient is that he

had an upper respiratory infection with a sore throat about 3 weeks ago

During the nursing assessment of any patient with a valvular disorder, the nurse would expect to find

murmurs

During postoperative teaching with a patient who has had a mitral valve replacement with a mechanical valve, the nurse instructs the patient regarding

the need for anticoagulation therapy for the duration of the valve

A 68 year old female is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than which of the following?

60

During the physical examination of a 56 yr-old male, the nurse palpates the PMI in the sixth intercostal space lateral to the midclavicular line. The most approriate interpretation of this finding is:

the patient may have left ventricular hypertrophy

To assess for jugular vein distention in a patient with congestive heart failure, the nurse will:

observe the vertical distention of the viens as the patient is gradually elevated to an upright position

A client presents to the ED in atrial fibrillation, The client has no medical history of this. The nurse anticipates the patient will be initially treated with:

anticoagulant therapy

Your patient is taking Crestor (rovastatin). In explaining the risks and benefits of this medication, you would tell the patient:

this medication helps prevent atherosclerosis, but may cause severe muscle pain.

To asses for JVD in a client with congestive heart failure, the nurse will:

observe the vertical distension of the vein as the patient gradually sits up.

A 45 year old male is admitted to the ED after developing severe chest pain while doing yardwork. On admission, he has a normal EKG. The physician schedules the client for a cardiac catheretization with coronary angiography and possible percutaneous coronary intervention (PCI). The nurse prepares the client for the procedure by explaining that, in his case, it is used to:

visualize blockages in the coronary arteries and dilate these with a small balloon

While caring for a patient with and acute myocardial infarction, the nurse monitors the patient carefully for the most common complication of:

arrhythmias

A client with diabetes mellitus is admitted unresponsive to the ED. Initial labs reveal: K+ 2.8, Na 138, Cl 90, glucose 628. Cardiac monitoring shows multifocal PVCs. The nurse understands that the PVCs are most likely from:

hypokalemia

You are caring for a patient on cardiac monitoring. The monitor show ventricular fibrillation. You are aware that this is associated with the absence of:

a palpable pulse
respirations
QRS complexes
all of the above

The nurse is caring for a patient with pericarditis, who has increasing complaints of chest pain. The nurse is aware that this may signify which of the following serious consequences of this diagnosis?

cardiac tamponade

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PVC

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