Get ahead with a $300 test prep scholarship
| Enter to win by Tuesday 9/24
2205 Coronary Heart Disease
NCLEX Style Practice Questions CH 30
Terms in this set (48)
The nurse, discussing coronary heart disease risk factors with a group of factory employees, would include which option(s) as modifiable risk factors? Select all that apply.
2. diabetes mellitus
Correct Answer: 1,2,3
Rationale 1: A person can make a choice to modify HTN by controlling it through meds, weight control, diet, & exercise.
Rationale 2: A person can make a choice to modify DM by controlling it through meds, weight control, diet, & exercise.
Rationale 3: A person can make a choice to obesity by controlling it through meds, weight control, diet, & exercise.
Rationale 4: Hereditary effects on coronary heart disease cannot be changed.
Rationale 5: Aging effects on coronary heart disease cannot be changed.
Which diagnostic test would the nurse anticipate as priority for a pt admitted with chest pain to determine coronary heart disease status?
1. coronary angiography
2. stress electrocardiography
4. radionuclide testing
Correct Answer: 1
Rationale 1: The gold standard for evaluating coronary arteries is coronary angiography. Visualization of the arteries is allowed with this method.
Rationale 2,3,4: The other tests may be used, but are not the primary exam. The remaining exams will probably not be done until the angiography is completed & analyzed.
Aspirin has been prescribed for a pt following a myocardial infarction. What should the nurse include in teaching about this drug?
1. Check with your healthcare provider before taking any herbal remedies.
2. Report any itching that develops after seven days of taking the drug.
3. Take at a different time of day than warfarin (Coumadin).
4. Do not skip any scheduled appointments to have blood drawn for labs.
Correct Answer: 1
Rationale 1: Herbal remedies such as evening primrose oil, garlic, gingko biloba, or grapeseed extract can increase the effect of the aspirin.
Rationale 2: Itching is not a common side effect of aspirin therapy.
Rationale 3: Aspirin & Coumadin are not to be taken concurrently.
Rationale 4: No lab appointments will be made just for aspirin therapy.
The nurse is assessing a pt who is six hours postoperative from coronary artery bypass graft (CABG) surgery. The pt's heart rate is 120, bp is 90/50, urine output is decreased, chest tube output is decreased, heart sounds are muffled, & peripheral pulses are diminished. What action should be taken by the nurse first?
1. Notify the physician immediately.
2. Recheck vital signs in 15 minutes.
3. Reposition the pt.
4. Increase the intravenous fluids.
Correct Answer: 1
Rationale 1: The pt is exhibiting signs of cardiac tamponade. This is an emergency, & the Dr. must be notified immediately.
Rationale 2: Delaying the response by waiting 15 minutes will be ineffective.
Rationale 3: Repositioning the pt will be ineffective.
Rationale 4: No change in intravenous fluids should be made until a physician order is given to do so.
During an office visit, a 55-yr-old female pt asks why she has not been prescribed a daily dose of aspirin. Her 56-yr-old husband has been advised by the physician to take a daily aspirin. What can the nurse explain is the most likely reason for this?
1. The benefit of aspirin in women under age 65 is not clear.
2. Aspirin is not recommended for women.
3. This must have been an oversight.
4. She has other meds that could interfere
Rationale 1: In women, the benefit of low-dose aspirin in reducing the risk for coronary heart disease is not clear prior to 65 years of age.
Rationale 2: Aspirin is recommended for women over the age of 65.
Rationale 3: This was not an oversight.
Rationale 4: There is not enough info to determine if the pt has other meds that could interfere with aspirin.
During a follow-up appointment after a myocardial infarction, a pt states, "My friends tell me to add more garlic to my diet & start drinking red wine each evening." Which response by the nurse is best?
1. "Discuss your idea with the physician to see what would benefit you."
2. "That sounds fine. See how they work."
3. "I wouldn't do that if I were you."
4. "You should also add ginkgo biloba for cardiovascular health."
Rationale 1: Complimentary therapies could be helpful. They should be added only after discussion with a healthcare provider who is familiar with the pt's history & current med/allergy list. Interactions between herbal preparations & prescribed meds are common.
Rationale 2: They should be added only after discussion with a healthcare provider who is familiar with the pt's history & current medication/allergy list.
Rationale 3: Since the pt has taken an interest in her health by discussing it with her friends, ignoring her comment or discouraging her would not be beneficial.
Rationale 4: The nurse should not add or approve any other complimentary therapies unless directed so by the physician.
During pt teaching about cardiac risk factors, the nurse knows that which laboratory test, if abnormal, requires further instruction due to the risk for the development of coronary artery disease?
1. elevated homocysteine
2. elevated creatinine
3. elevated high density lipoprotein (HDL)
4. elevated INR
Rationale 1: Elevated levels of homocysteine (Hyc > 15 µmol/L) are associated with an increased risk of coronary artery disease (CAD). Homocysteine is an amino acid that is a by-product of the enzyme reactions from meat, dairy products, vitamin, & mineral metabolism. Homocysteine causes endothelial ulceration & scarring, & increases procoagulant properties of blood, all leading to an increase in the risk of thrombus formation.
Rationale 2: Elevated creatinine indicates kidney disease.
Rationale 3: HDL is the good cholesterol & when elevated it will decrease the risk for the development of CAD.
Rationale 4: INR is a laboratory test that measures blood clotting function, not CAD.
The nurse, caring for a pt admitted w/ chest pain, realizes that which factor places the pt at the highest risk for heart disease?
1. overweight & carries the weight around the waist
2. mother died at age 70 of an acute myocardial infarction
3. a single mother of four young children with a low income
4. has a desk job & works long hours
Rationale 1: Fat accumulation in the upper body, giving the body an appearance of an "apple," has been linked to a greater risk of coronary artery disease (CAD) as opposed to a "pear" shape with body fat accumulation in the gluteofemoral region. Abdominal obesity is associated with elevated levels of cholesterol & greater risk for CAD.
Rationale 2: If the pt's mother had died before age 55, that would be a risk factor.
Rationale 3: Being a single mother is not a specific risk factor for the development of CAD.
Rationale 4: Sedentary life style is a risk factor, but not as significant as fat accumulation in the upper body.
The nurse, assessing a middle-aged pt experiencing chest pain, realizes that presence of which symptoms would be most characteristic of an acute myocardial infarction?
1. substernal pressure type pain, radiating down the left arm
2. colic-like epigastric pain
3. sharp, well-localized unilateral chest & left arm pain
4. sharp, burning chest pain moving from place to place
Rationale 1: Terms such as burning, crushing, suffocating, & pressure are typical descriptors of chest pain from myocardial ischemia, often with pain radiating to other areas of the upper torso.
Rationale 2: Cardiac chest pain is not usually described as colic-like, localized to a defined spot such as the epigastric area, or as a sharp pain.
Rationale 3: Cardiac chest pain is not usually described as localized to a defined spot or as a sharp pain.
Rationale 4: Cardiac chest pain is not usually described as a sharp pain.
The nurse, caring for a pt diagnosed with Prinzmetal's or variant angina, realizes this is a serious type of chest pain. Why is this so?
1. It indicates presence of coronary artery spasm.
2. It indicates there is associated renal disease.
3. It indicates there is associated pulmonary disease.
4. It indicates the presence of a myocardial infarction.
Rationale 1: Variant, Prinzmetal's, or vasospastic angina is a serious type of angina. It occurs when single or multiple sites in major coronary arteries & their large branches have vasospasm, thereby cutting off the blood supply to an area of the myocardium.
Rationale 2: Prinzmetal's angina does not occur due to renal disorders.
Rationale 3: Prinzmetal's angina does not occur due to a pulmonary disorder.
Rationale 4: Prinzmetal's angina is not specifically diagnostic for a myocardial infarction.
A pt enters the ER complaining of chest pain that is radiating down the left arm. The emergent treatment plan for this pt includes which nursing actions? Select all that apply.
1. morphine intravenously & oxygen
2. aspirin 325 mg orally
3. open heart surgery
4. heparin drip at 100 units per hour
5. Foley catheter insertion
Rationale 1: The mnemonic MONA, cited in the Advanced Cardiac Life Support (ACLS) guidelines, describes a protocol for treatment of pts with suspected myocardial infarction. The mnemonic stands for morphine, oxygen, nitroglycerin, & aspirin. While the mnemonic does not imply a correct sequencing of treatment, it does describe a protocol for treatment of pts with suspected myocardial infarction.
Rationale 2: The mnemonic MONA, cited in the Advanced Cardiac Life Support (ACLS) guidelines, describes a protocol for treatment of pts with suspected myocardial infarction. The mnemonic stands for morphine, oxygen, nitroglycerin, & aspirin. While the mnemonic does not imply a correct sequencing of treatment, it does describe a protocol for treatment of pts with suspected myocardial infarction.
Rationale 3: Open heart surgery may be indicated later, but not on admission to the ER.
Rationale 4: Heparin is not part of the admission protocol.
Rationale 5: A Foley catheter is not part of the admission protocol.
Following a transmural myocardial infarction, which ECG change stays with the pt for life?
1. Q wave deepening
2. ST segment elevation
3. ST segment depression
4. P wave inversion
Rationale 1: The development of an abnormal Q wave is a definitive diagnostic sign of myocardial necrosis. Since it is indicative of necrosis, it stays with the pt for life.
Rationale 2: ST segment elevation represents myocardial ischemia, which is reversible by increasing the blood flow to the heart.
Rationale 3: ST segment depression occurs when muscle ischemia involves only a portion of the heart wall.
Rationale 4: P wave inversion represents a junctional pacemaker in the heart & is not related to changes that occur with a myocardial infarction.
A pt reports chest pain, nausea, & vomiting off & on for the last 4 days, which the pt interpreted as the flu. Which lab tests will provide info about acute cardiac damage for this pt?
1. Troponin I & T
2. Red blood cells
4. Homocysteine & platelets
Rationale 1: The levels of Troponin T begin to rise within 3-6 hours after myocardial injury & remain elevated 14-21 days. Levels of Troponin I begin to increase in about 3-5 hours after myocardial ischemia & peak at 14--18 hours & remain elevated for 5--7 days.
Rationale 2: Red blood cells are unaffected by acute cardiac damage.
Rationale 3: The CPK-MB rises within 3-6 hours after the MI, peaks within 12-24 hours & levels return to normal 2-3 days following the infarction. This pt would most likely have normal valves 4 days out from the onset of symptoms.
Rationale 4: Homocysteine does not change with acute cardiac damage. Platelets are unaffected by acute cardiac damage.
Fifteen hours after admission, a pt's CPK-MB level is markedly increased. What does this indicate to the treatment team?
1. Cellular necrosis of myocardial tissue has occurred.
2. Lactic acid is present.
3. Thrombolytic therapy is indicated.
4. Cardiac function has returned to normal.
Correct Answer: 1
Rationale 1: CPK-MB is the intracellular enzyme that is released when cell damage & death occur. CPK-MB becomes elevated when myocardial cell death has occurred.
Rationale 2: The pH is the indicator of lactic acid buildup.
Rationale 3: Thrombolytic therapy is indicated within the first 12 hours after symptoms develop, thus, it is too late for this intervention.
Rationale 4: Cardiac function has not returned to normal.
The nurse, caring for a pt with myocardial damage, would expect which change on the ECG tracing?
1. ST segment elevation
2. loss of P waves
5. widening of the QRS complex
Rationale 1: Transmural damage is present with ST segment elevation.
Rationale 2: Loss of P waves occurs with atrial flutter & fibrillation.
Rationale 3: Bradycardia can be a normal or abnormal rhythm. It's not specifically associated w/ transmural damage.
Rationale 4: Widening of the QRS complex occur with bundle branch block. It is not specifically associated with transmural damage.
The nurse, caring for a pt recovering from an acute myocardial infarction, realizes that the final extent of cardiac damage is dependent upon which factor?
1. reperfusion of the ischemic zone
2. pt's ethnicity
3. pt's gender
4. development of heart block
Rationale 1: Surrounding the area of infarction is the zone of injury & the zone of ischemia. These zones are made of potentially viable tissues. They can become necrotic & die, or be reperfused & remain functional. The goal of treatment for an AMI is to establish reperfusion as early as possible to prevent necrosis & salvage the myocardium.
Rationale 2: The pt's ethnicity does not impact the final extent of cardiac damage.
Rationale 3: The pt's gender does not impact the final extent of cardiac damage.
Rationale 4: Developing a heart block does not impact cardiac damage.
Nursing care of the pt after thrombolytic therapy focuses on the assessment of which finding that is the most common complication?
2. reperfusion chest pain
4. heart block
Rationale 1: Hemorrhage or bleeding is the most common complication; it can be life-threatening.
Rationale 2: Recurrent chest pain is not associated with thrombolytic therapy.
Rationale 3: Lethargy is not associated with thrombolytic therapy.
Rationale 4: Heart block is not associated with thrombolytic therapy.
Upon auscultating the chest of a 75-year-old pt who recently experienced a myocardial infarction (MI) the nurse hears an S3 & lung crackles. Because of these findings, the nurse would assess for which other condition?
1. heart failure
2. extension of the MI
3. renal failure
4. liver failure
Rationale 1: S3 & lung crackles are indications of heart failure.
Rationale 2: Manifestations of MI extension include chest pain & a return of positive lab finding (CPK-MB & troponin).
Rationale 3: Renal failure is a late complication of heart failure & is not manifested with an S3 & crackles.
Rationale 4: Liver failure is not manifested with an S3 & crackles.
The nurse is teaching a pt about coronary artery bypass surgery. Which statement, included in this teaching, is essential for the pt to understand?
1. "You must still reduce or modify cardiac risk factors."
2. "This surgery prolongs life on an average of two years."
3. "You have only a minimal chance of functional improvement, even with this surgery."
4. "This surgery will cure your atherosclerosis."
Rationale 1: It is essential that the pt understand that the goal of the surgery is to relieve the symptoms & improve the quality of life. The pt must still reduce or modify controllable risk factors to retard the underlying process.
Rationale 2: Research indicates that life expectancy is prolonged by greater than 15 years following CABG. Less than 10% of pts who undergo CABG will need subsequent revascularization within five to seven years.
Rationale 3: CABG provides more complete revascularization & show better long-term relief of symptoms than percutaneous coronary interventions.
Rationale 4: The surgery is not done to cure atherosclerosis.
A pt, recovering from coronary artery bypass graft (CABG) surgery, tells the nurse that it feels good to be cured of heart disease. Which of the following is the most appropriate response for the nurse to make?
Select all that apply.
1. "The surgery only relieves the symptoms; it does not cure the disease."
2. "You must continue to modify your cardiac risk factors."
3. "You are correct; your heart is now normal."
4. "You should not ever exercise again."
5. "There no need to monitor your fat intake any longer."
Rationale 1: Denial is a common coping mechanism with cardiac pts; therefore, it is essential that the nurse stress that CABG is not a cure for coronary artery disease (CAD).
Rationale 2: Atherosclerosis is a progressive disease; therefore, the pt needs to continue to modify risk factors.
Rationale 3: CABG only relives symptoms, it does not cure the disease.
Rationale 4: The pt should begin a cardiac rehabilitation program with a progressive exercise program.
Rationale 5: The pt must continue to modify risk factors such as fat intake.
Which of the following should the nurse do to assist a pt recovering from cardiovascular surgery who is demonstrating chest tube output of greater than 100 mL per hours? Select all that apply.
1. Report to the surgeon.
2. Check the hemoglobin & hematocrit.
3. Administer a blood transfusion.
4. Notify the family.
Rationale 1: It's abnormal to have > 100 mL of drainage in 1hr. It may indicate bleeding & needs to be assessed by the surgeon.
Rationale 2: Hemoglobin & hematocrit should be checked.
Rationale 3: The pt needs to be assessed along with the lab data before it is determined if a blood transfusion is necessary.
Rationale 4: There is no need to notify family until the pt has been assessed. It may not be of significance.
The family of a pt who experienced a stroke after CABG surgery asks the nurse what caused the stroke to occur. The nurse's best response would be which of the following?
1. "Stroke is usually caused by a blood clot that brakes loose & travels to the brain."
2. "Stroke is usually caused by ruptured plaque inside the coronary artery."
3. "Stroke is caused by heart failure."
4. "No one knows what causes strokes."
Rationale 1: Stroke is usually caused by an embolus from the ascending aorta or aortic arch, which travels through the heart into the vessels leading to the brain.
Rationale 2: Plaque inside a coronary artery would travel downstream & lodge in a smaller vessel in the heart.
Rationale 3: Heart failure does not cause a stroke.
Rationale 4: Stating that no one knows what causes strokes is not a true statement; blood clots & ruptured vessels cause strokes.
Coronary heart disease (CHD) is a major problem in the United States. Pts with which history may require closer evaluation for CHD? Select all that apply.
3. positive family history
4. a premenopausal woman
Rationale 1: Diabetes is a disease condition that contributes to coronary heart disease (CHD).
Rationale 2: Hyperlipidemia is a disease condition that contributes to CHD.
Rationale 3: Positive family history in some cases is considered a nonmodifiable risk factor for CHD.
Rationale 4: Women experiencing premature menopause (not premenopausal women) is also a condition to be evaluated.
Rationale 5: Hypotension is not associated with development of CHD.
A nurse is conducting teaching about risk factor management for cardiovascular disease (CVD) at a senior center. What is the most important info for the nurse to include?
1. Stop smoking.
2. Eat in moderation.
3. Exercise when able.
4. Reduce saturated fats in the diet.
Rationale 1: Cigarette smoking is the leading independent risk factor for coronary heart disease.
Rationale 2,3,4: The remaining options are teaching points, but are not specific. The problems associated with the remaining options are not as significant as smoking.
The pt asks the nurse about metabolic syndrome. Which is the most accurate answer for the nurse to provide?
1. "Metabolic syndrome is caused by obesity, physical inactivity, & genetic factors."
2. "This syndrome is not a concern for females unless they smoke."
3. "This problem affects only older adults over the age of 65."
4. "It can be avoided by taking vitamins daily & drinking 64 fluid ounces of water a day."
Rationale 1: Metabolic syndrome is caused by obesity, physical inactivity, & genetic factors.
Rationale 2: The syndrome is not directly related to smoking.
Rationale 3: The syndrome is not directly related to age.
Rationale 4: Daily vitamin & fluid consumption have not been found to alter the syndrome.
What info does the nurse consider when administering medication to treat hyperlipidemia?
1. Such meds include the statins, which act by lowering LDL levels.
2. These meds act by increasing the LDL levels & decreasing the HDL levels.
3. These meds do not include angiotensin-converting enzyme (ACE) inhibitors.
4. Such meds include bile acid sequestrants as first-line drugs to lower cholesterol levels.
Rationale 1: The statin drugs specifically lower LDL.
Rationale 2: Hyperlipidemia drugs are meant to lower LDL & raise HDL, not the opposite.
Rationale 3: Angiotensin-converting enzyme (ACE) inhibitors are appropriate to add to drug treatment for high-risk pts.
Rationale 4: Bile acid sequestrant drugs are not first-line drugs but may be added to statins when combination treatment is needed.
A pt who is prescribed atorvastatin (Lipitor) should be monitored for which occurrence?
1. liver enzyme alteration
2. blood glucose & uric acid level alteration
3. renal function alteration
4. sudden back pain & constipation
Rationale 1: The nurse should be observing lab work for the current cholesterol level & to ensure that liver enzymes remain normal.
Rationale 2: Blood glucose & uric acid level are generally not associated with the use of this drug.
Rationale 3: Renal function alteration is generally not associated with the use of this drug.
Rationale 4: Constipation & sudden back pain are generally not associated with the use of this drug
The nurse completed teaching related to dietary management of coronary heart disease (CHD). Effective teaching would be indicated by which pt statement?
1. "I can lower my trans fatty acids by switching to the soft margarines & vegetable spreads."
2. "I will watch my fiber intake so I don't get too much."
3. "Well, I'll just have to go buy some of that coconut oil to cook with."
4. "Drinking a couple of glasses of milk each day will give me better protein."
Rationale 1: Trans fatty acids behave like saturated fats & are found in solid vegetable fats (margarine, shortening) & stick butter, therefore the use of soft margarines & vegetable spreads is recommended for managing CHD.
Rationale 2: Other dietary recommendations include reduced intake of saturated fats & cholesterol & increased soluble & insoluble fiber in the diet.
Rationale 3: High proportions of saturated fats are found in coconut oil & red meats.
Rationale 4: High proportions of saturated fats are found in whole-milk products.
The nurse is assessing a pt who is currently experiencing chest pain. The pt has a previous diagnosis of chest pain but now reports an increase in the frequency & duration. Appropriate nursing care for this type of chest pain includes which nursing intervention?
1. aspirin 325 mg PO per day per physician prescription
2. bed rest with bathroom privileges
3. aluminum hydroxide (Maalox) 5 mL PO PRN per physician prescription
4. atropine (Atropair) 0.4 mg IVP PRN per physician prescription
Rationale 1: Aspirin is considered helpful due to its antiplatelet effects.
Rationale 2: Bed rest with bathroom privileges would not necessarily be indicated in this situation.
Rationale 3: Antacids are used to treat heartburn or upset stomach.
Rationale 4: Atropine (Atropair) is used to dry secretions & stimulate cardiac function, not for chest pain.
A 52-year-old obese male pt who is admitted with elevated triglycerides & a history of smoking two packs of cigarettes a day for 20 years asks about his risk for coronary artery disease. What info should the nurse provide?
1. He is at risk for coronary artery disease.
2. He is not at risk for coronary artery disease.
3. He possesses all nonmodifiable risk factors for coronary artery disease that cannot be overcome.
4. He possesses all modifiable risk factors for coronary artery disease that can be overcome.
Rationale 1,2,3,4: Age is a nonmodifiable risk factor & obesity, elevated triglycerides & smoking are modifiable risk factors. Together the risk factors place the pt at higher risk to develop coronary artery disease.
The nurse is caring for an adult pt who is admitted with chest pain that began four hours ago. Which test will be most specific in identifying acute heart damage?
Rationale 1: Troponin is primarily located in cardiac muscle & can indicate myocardial infarction or unstable angina. Troponin elevates at two to four hours after myocardial infarction.
Rationale 2,3: CPK & CK-MB will elevate with myocardial damage, but will take longer to rise & are not as specific as troponin.
Rationale 4: Cholesterol level is not helpful in diagnosis of myocardial damage.
The nurse realizes that the pt in the critical care area with ventricular tachycardia will require which action? Select all that apply.
1. immediate assessment & probable emergency intervention by the nurse
2. cardioversion, if sustained & symptomatic
3. probable administration of a potassium channel blocker
4. close observation for one hour prior to calling the physician
5. defibrillation to convert the rhythm in the awake pt
Correct Answer: 1,2,3
Rationale 1: The nurse should immediately assess the pt to see how the potentially life-threatening rhythm is being tolerated.
Rationale 2: The nurse should be prepared to cardiovert the pt in ventricular tachycardia with a pulse according to standing prescriptions. The nurse in critical care needs to be aware of standing prescriptions for each pt prior to an emergent event & needs to have the necessary emergency equipment & meds ready.
Rationale 3: Class III antidysrhythmic meds (potassium channel blockers) are typically administered.
Rationale 4: Observation prior to calling a physician is not an appropriate action when a potentially life-threatening rhythm is identified.
Rationale 5: Defibrillation is only conducted in ventricular tachycardia when the pt is pulseless; otherwise, time is taken to synchronize for cardioversion.
Which is the priority nursing intervention for a pt with a junctional escape rhythm?
1. Assess the pt for symptoms associated with this rhythm.
2. Contact the physician immediately for emergency orders.
3. Eliminate caffeine from the diet.
4. Prepare for a pacemaker insertion.
Rationale 1: Junctional escape rhythms may be monitored if the pt is not symptomatic. It is most important to assess the pt to see how they are affected by the rhythm.
Rationale 2: Then, calling the physician to report the rhythm may be appropriate.
Rationale 3: Eliminating caffeine is not an appropriate action for this pt with a junctional escape rhythm. No indication of symptoms relating to the rhythm was given.
Rationale 4: Preparing for a pacemaker insertion is not an appropriate action for this pt with a junctional escape rhythm. No indication of symptoms relating to the rhythm was given.
The nurse is caring for a pt who develops atrial fibrillation with a heart rate above 100 bpm. Place the following nursing actions in sequence from the highest priority to the lowest priority.
Click & drag the options below to move them up or down.
Choice 1. Assess the pt for comfort level & vital signs.
Choice 2. Check the patency of an intermittent IV.
Choice 3. Check the pt's chart for lab results from today's tests.
Choice 4. Call the physician to report the dysrhythmia.
Rationale 1: Assess the pt first.
Rationale 2: Check the patency of the IV in case it is needed for anticipated medication administration.
Rationale 3,4: Check for lab results prior to calling the physician in order to respond to the physician's questions before the physician gives prescriptions.
The nurse is instructing a pt on nitroglycerin tablets prescribed to treat angina. Which statement(s) should be included in the nurse's instructions? Select all that apply.
1. "Take a second dose if the angina is not relieved within five minutes."
2. "The drug should remain in this brown bottle since it is sensitive to light."
3. "Store this medication in your bathroom medicine cabinet so it is readily available to you."
4. "Eating or drinking will not interfere when taking the medication."
5. "Call your doctor immediately if you develop a headache when taking this drug."
Correct Answer: 1,2
Rationale 1: A second dose of nitrates is recommended within five minutes if the first dose does not relieve the angina.
Rationale 2: Sublingual nitrates should not be removed from their original amber bottle since it protects the medication from light.
Rationale 3: They should be stored in a dry location & not placed in the bathroom medicine cabinet since moisture affects nitrates.
Rationale 4: This medication is taken sublingually, therefore eating & drinking will interfere with absorption.
Rationale 5: A transient headache may occur when taking this medication & will diminish over time.
Sinus bradycardia (rate 56 bpm) is identified in a sleeping pt on telemetry. Which is the priority nursing action?
1. Awaken the pt & see how the heart rate responds.
2. Call the physician & report this dysrhythmia.
3. Check the medication administration record & see if there is a PRN medication that will improve this rhythm.
4. Call for an immediate 12-lead electrocardiogram (ECG).
Rationale 1: The priority is to awaken the pt to determine how the heart rate is affected with activity as it normally should increase. The pt should be evaluated to determine how the dysrhythmia is affecting heart function. Many pts who are asymptomatic while in sinus bradycardia can be observed & require no further intervention. Common reasons for sinus bradycardia for the nurse to consider include athletic conditioning, sleep, or a conduction disorder.
Rationale 2: Notifying the physician without first assessing the pt's response would not be appropriate.
Rationale 3: The priority is to awaken the pt to determine how the heart rate is affected with activity as it normally should increase. The pt should be evaluated to determine how the dysrhythmia is affecting heart function. Many pts who are asymptomatic while in sinus bradycardia can be observed & require no further intervention.
Rationale 4: Ordering an ECG requires a physician's prescription.
A pt is in sinus tachycardia. Which nursing interventions are appropriate? Select all that apply.
1. Observe the pt for effects on cardiac function.
2. Administer two tablets of acetaminophen (Tylenol) per physician prescription if an elevated temperature is present.
3. Administer normal saline 0.9% IV at the prescribed rate of 200 mL per hour if hypovolemia is suspected as the cause.
4. Give pain meds as prescribed if pain is present.
5. Give atropine per physician prescription to slow the heart rate.
Correct Answer: 1,2,3,4
Rationale 1: Appropriate nursing interventions for the pt in sinus tachycardia are to observe the pt for effects on cardiac function; treat fever, hypovolemia, & pain if present. The focus is on determining the pt response to the elevated heart rate & treating the underlying causes, which are often fever, pain, & hypovolemia.
Rationale 2: Appropriate nursing intervention for the pt in sinus tachycardia is to treat fever
Rationale 3: Appropriate nursing intervention for the pt in sinus tachycardia is to treat hypovolemia.
Rationale 4: Appropriate nursing intervention for the pt in sinus tachycardia is to treat pain if present.
Rationale 5: Atropine acts to increase heart rate & may be a cause of sinus tachycardia.
The term pacemaker noncapture requires which nursing action(s)? Select all that apply.
1. Contact the physician & describe what is noted on the ECG strip.
2. Assess the pt to determine response to the pacemaker noncapture.
3. Document the event by printing the ECG strip & placing it on the pt's record.
4. Ask the pt to ambulate to increase cardiac output.
5. Administer nitroglycerin sublingual one dose stat according to physician prescription.
Correct Answer: 1,2,3
Rationale 1: Actions the nurse should take when noncapture occurs include contacting the physician & describing the ECG strip.
Rationale 2: Actions the nurse should take when noncapture occurs include assessing the pt to determine the response to the noncapture event.
Rationale 3: Actions the nurse should take when noncapture occurs include documenting the event by printing an ECG strip & placing it on the pt's record.
Rationale 4: Having the pt ambulate would not be indicated for pacemaker malfunction.
Rationale 5: Administering nitroglycerin would not be indicated for pacemaker malfunction. Nitrogycerin is administered for chest pain.
The pt has a pacemaker with one pacing spike seen on the ECG before every QRS complex. There is no change in the pacemaker rhythm over time, with rest or with activity. The nurse realizes that this means that this which type of pacemaker?
1. asynchronous pacing
2. demand pacing
3. dual-chamber pacing
4. atrial single-chamber pacing
Correct Answer: 1
Rationale 1: Considerations when determining the type of pacemaker include the pacing spike frequency noted on the ECG, the location within each complex, & whether it is fixed or intermittent. An asynchronous pacemaker produces the description provided.
Rationale 2: A demand pacemaker spike varies with the heart rate.
Rationale 3: A dual-chamber pacer normally produces two pacing spikes, one before the P wave & one before the QRS.
Rationale 4: An atrial pacer would produce a spike, normally with a P wave that follows it prior to the QRS.
The nurse is notified by the cardiac monitoring technician that a pt on continuous cardiac monitoring is having frequent alarms. When the nurse enters the pt's room, the pt is in no apparent distress, is sitting in the chair & eating. Which are appropriate nursing interventions? Select all that apply.
1. Confirm that lead wires are properly connected.
2. Assess placement of electrodes.
3. Remove & reapply new electrodes if nonadherent.
4. Assess skin sites & move an electrode if the skin appears irritated.
5. Call for assistance.
Correct Answer: 1,2,3,4
Rationale 1: Nursing actions include assessing lead wire connections.
Rationale 2: Nursing actions include assessing placement of electrodes.
Rationale 3: Nursing actions include changing electrodes every 24 to 48 hours or removing & reapplying electrodes that are dislodged or nonadherent.
Rationale 4: Nursing actions include assessing & documenting skin condition under the pads & moving pads to alternate sites to avoid skin irritation.
Rationale 5: Since the pt is in no apparent distress, assistance is not required.
A pt reports the following symptoms to the nurse: nausea, loss of appetite, blurred & double vision, green yellow halos, vomiting & "feeling uneasy."." What situation should the nurse suspect?
1. digoxin toxicity
2. lidocaine toxicity
3. amiodarone toxicity
4. procainamide toxicity
Rationale 1: Classic symptoms of digoxin toxicity include anorexia, nausea, vomiting, blurred or double vision, yellow green halos, & new-onset dysrhythmias.
Rationale 2: Lidocaine toxicity is manifested by changes in neurologic status.
Rationale 3: Amiodarone toxicity is manifested by altered hepatic function, pulmonary fibrosis, & photosensitivity.
Rationale 4: Procainamide toxicity is manifested by flu-like symptoms, skin rash, & signs of heart failure.
A pt is having elective synchronized cardioversion. Place the following steps of the procedure in the correct order. Click & drag the options below to move them up or down.
Choice 1. Verify patency of IV access.
Choice 2. Administer sedative per physician prescription.
Choice 3. Set cardioverter to "synchronize" mode.
Choice 4. Place conductive pads on the pt's chest.
Choice 5. Charge the cardioverter to the selected energy level. Remove oxygen.
Choice 6. Personnel step away from the bed prior to delivery of the electrical shock.
Rationale 1: IV access is necessary for emergency drug administration & should be verified before the procedure is begun.
Rationale 2: Pt comfort is maintained through administration of the prescribed sedation prior to the cardioversion.
Rationale 3: The correct function of the cardioverter is set to synchronize mode.
Rationale 4: Conductive pads are applied.
Rationale 5: The cardioverter is charged to the selected energy level. Oxygen is removed since an electrical shock could cause oxygen combustion.
Rationale 6: Personnel should not be touching the bed prior to & during delivery of the shock.
Premature ventricular contractions (PVCs) are best characterized by which statement?
1. They are insignificant in people with no history of heart disease.
2. PVCs typically have no pattern.
3. The frequency of PVCs is not associated with specific events.
4. Their incidence & significance has no relevance to the pt having had a myocardial infarction.
Rationale 1: PVCs often have no significance in people without history of heart disease.
Rationale 2: PVCs may be isolated or occur in specific patterns.
Rationale 3: They may be triggered by anxiety or stress; tobacco, alcohol or caffeine use; hypoxia, acidosis, & electrolyte imbalances; sympathomimetic drugs; & coronary heart disease.
Rationale 4: They may be associated with an increased risk for lethal dysrhythmias & their incidence & significance is greatest after myocardial infarction.
A nurse is performing cardiopulmonary resuscitation (CPR) on a pt who is in cardiac arrest. An automatic external defibrillator (AED) is available. Which activity will allow the nurse to assess the pt's cardiac rhythm?
1. Apply adhesive patch electrodes to the chest & move away from the pt.
2. Apply standard electrocardiographic monitoring leads to the pt & observe the rhythm.
3. Hold the defibrillator paddles directly against the pt's chest.
4. Connect electrocardiographic electrodes to a telephone monitoring device & wait until the rhythm is analyzed.
Rationale 1: The nurse applies adhesive patch electrodes to the pt's chest in the usual defibrillator positions, stops CPR, & orders everyone near the pt to move away & not touch the pt. The defibrillator analyzes the rhythm, which may take up to 30 seconds. The machine then indicates if defibrillation is indicated.
Rationale 2: Standard electrocardiographic monitoring leads are not used with an AED.
Rationale 3: Defibrillator paddles are not used with an AED.
Rationale 4: Telephone monitoring devices are not used with an AED.
A pt received an implantable cardioverter-defibrillator (ICD). The nurse would include which instruction during discharge teaching for this pt?
1. "If a family member is in direct contact with you when the ICD discharges, he or she may experience a shock or tingling sensation."
2. "You can activate the ICD whenever you feel a change in your heart rhythm."
3. "The batteries of the ICD won't need to be replaced if the ICD never shocks the heart."
4. "There should be no discomfort if the ICD discharges & you probably won't notice it."
Rationale 1: Family members may receive a shock or tingling sensation when in direct contact with an individual when their ICD discharges.
Rationale 2: The ICD is programmed to automatically activate when detecting a potentially lethal cardiac rhythm & cannot be activated by the pt.
Rationale 3: Batteries must be surgically replaced every five years or following manufacturer's instructions.
Rationale 4: Some pts experience significant discomfort with ICD discharge.
A nurse is preparing a presentation on coronary heart disease (CHD) for a community women's club. Which statement(s) should the nurse include in the presentation? Select all that apply.
1. Epigastric pain & nausea are often experienced with a heart attack but attributed to heartburn.
2. Common symptoms of myocardial infarction (MI) include shortness of breath & fatigue.
3. Women are more likely to have an unrecognized myocardial infarction.
4. Weakness of the legs & back often precede a heart attack.
5. The mortality rate of young women having an MI is 50 % lower than that of men.
Rationale 1& 2: Common symptoms of MI in women include epigastric pain or nausea, which is blamed on heartburn, shortness of breath, fatigue, & weakness of the shoulders & upper arms.
Rationale 3: "Silent" or unrecognized heart attack occurs more frequently in women than men.
Rationale 4: Weakness of the legs & back does not precede a heart attack.
Rationale 5: The mortality rate of young women having an MI is twice that of men.
The nurse is reviewing a new prescription for propranolol (Inderal) for a pt with coronary heart disease (CHD). The nurse would call the physician & question this prescription if the pt has which history?
1. has a history of asthma & chronic obstructive pulmonary disease (COPD)
2. is also taking antioxidants
3. is also taking simvastatin (Zocor)
4. has a history of bleeding disorders
Rationale 1: Class II beta-blockers such as propranolol are used to reduce heart rate & myocardial contractility & in the treatment of supraventricular tachycardia. These drugs may cause bronchospasm & are contraindicated for pts with asthma, chronic obstructive pulmonary disease (COPD), or other restrictive or obstructive lung diseases.
Rationale 2: Antioxidants may be taken concurrently.
Rationale 3: Simvastatin may be taken concurrently.
Rationale 4: Bleeding disorders are not associated with propranolol use.
Angina that is characterized as atypical, occurs unpredictably & often at night & is associated with coronary artery spasm would be labeled as which type of angina?
1. Prinzmetal's (variant) angina
2. stable angina
3. unstable angina
4. ischemic angina
Rationale 1: Prinzmetal's (variant angina) is atypical angina that occurs unpredictably (unrelated to activity) & often at night. It is caused by coronary artery spasm.
Rationale 2: Stable angina occurs with a predictable amount of activity or stress & occurs when the work of the heart is increased.
Rationale 3: Unstable angina is characterized by considerable unpredictable pain, occurs with either increasing or decreasing levels of activity or stress & may occur with rest.
Rationale 4: Ischemic angina may occur with either activity or mental stress & is considered asymptomatic.