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Chapter 35 Cardiovascular
Terms in this set (29)
The nurse is caring for a client with an arterial line. How does the nurse recognize that the client is at risk for insufficient perfusion of body organs?
A. Right atrial pressure is 4 mm Hg.
B. Mean arterial pressure is 58 mm Hg.
C. Pulmonary artery wedge pressure (PAWP) is 7 mm Hg.
D. PO2 is reported as 78 mm Hg.
Mean arterial pressure is 58 mm Hg.
The nurse in a coronary care unit interprets information from hemodynamic monitoring. The client has a cardiac output of 2.4 L/min. Which of the following actions should be taken by the nurse?
A. No intervention is needed; this is a normal reading.
B. Collaborate with the physician to administer a positive inotropic agent.
C. Administer a stat dose of metoprolol (Lopressor).
D. Ask the client to perform the Valsalva maneuver.
Collaborate with the physician to administer a positive inotropic agent.
Normal cardiac output is 4 to 7 L/min.
Which client will be best for the charge nurse to assign to a new graduate RN who has completed 2 months of orientation to the coronary care unit?
A. Client who has a new diagnosis of heart failure and needs a pulmonary artery catheter inserted
B. Client who has just arrived after a coronary arteriogram and has vital signs requested every 15 minutes
C. Client with acute electrocardiographic changes who is requesting nitroglycerin for left anterior chest pain
D. Client who has many questions about the electrophysiology studies (EPS) scheduled for today
Client who has just arrived after a coronary arteriogram and has vital signs requested every 15 minutes
Which action should the nurse delegate to experienced unlicensed assistive personnel (UAP) working in the cardiac catheterization laboratory?
A. Assess preprocedure medications the client took that day.
B. Have the client sign the consent form before the procedure is performed.
C. Educate the client about the need to remain on bedrest after the procedure.
D. Obtain client vital signs and a resting electrocardiogram (ECG).
Obtain client vital signs and a resting electrocardiogram (ECG).
An RN and an LPN/LVN, both of whom have several years of experience in the intensive care unit, are caring for a group of clients. Which client will be appropriate for the RN to assign to the LPN/LVN?
A. A client with pulmonary edema who requires hourly monitoring of pulmonary artery wedge pressures
B. A client who was admitted with peripheral vascular disease and needs assessment of the ankle-brachial index
C. A client who has intermittent chest pain and requires teaching about myocardial nuclear perfusion imaging
D. A client with acute coronary syndrome who has just been admitted and needs an admission assessment
A client who was admitted with peripheral vascular disease and needs assessment of the ankle-brachial index
All of this information is obtained by the nurse who is admitting a client for a coronary arteriogram. Which information is most important to report to the physician before the procedure begins?
A. The client has had intermittent substernal chest pain for 6 months.
B. The client develops wheezes and dyspnea after eating crab or lobster.
C. The client reports that a previous arteriogram was negative for coronary artery disease.
D. The client has peripheral vascular disease, and the dorsalis pedis pulses are difficult to palpate.
The client develops wheezes and dyspnea after eating crab or lobster.
A 72-year-old client admitted with fatigue and dyspnea has elevated levels of all of these laboratory results. Which finding is consistent with acute coronary syndrome (ACS) and should be communicated immediately to the physician?
A. White blood cell (WBC) count
B. Low-density lipoproteins
C. Serum troponin I level
D. C-reactive protein
Serum troponin I level
The nurse is assessing a client with mitral stenosis who is to undergo a transesophageal echocardiogram (TEE) today. Which nursing action is essential?
A. Auscultate the client's precordium for murmurs.
B. Teach the client about the reason for the TEE.
C. Reassure the client that the test is painless.
D. Validate that the client has remained NPO.
Validate that the client has remained NPO.
Which assessment finding for a client with left ventricular failure who is receiving pulmonary artery pressure (PAP) monitoring indicates a need for rapid action by the nurse?
A. The waveform shows that the catheter is continuously in the wedge position.
B. Pulmonary artery wedge pressure (PAWP) is 12 to 14 mm Hg.
C. The sterile dressing at the catheter insertion site has a bloody area that measures 1 cm.
D. The chest x-ray shows the tip of the catheter in the pulmonary artery.
The waveform shows that the catheter is continuously in the wedge position.
Because a pulmonary infarction can occur if the catheter is left in the wedged position, the nurse should have the client cough and/or should change the client's position. If the catheter remains wedged, the physician should be notified immediately.
A client recovering from a cardiac angiography develops slurred speech. What does the nurse do first?
A. Maintains NPO (nothing by mouth) until this resolves
B. Calls in another nurse for a second opinion
C. Performs a complete neurologic assessment and notifies the physician
D. Explains to the client and family that this is expected after sedation
Performs a complete neurologic assessment and notifies the physician
Based on this assessment, the client most probably is suffering a neurologic bleed. Neurologic changes, such as visual disturbances, slurred speech, swallowing difficulties, and extremity weakness, should be reported immediately for prompt intervention.
Which statement about diagnostic cardiovascular testing is true?
A. Complications of coronary arteriography include stroke, nonlethal dysrhythmias, arterial bleeding, and thromboembolism.
B. An alternative to injecting a medium into the coronary arteries is intravascular ultrasonography.
C. Halter monitoring allows periodic recording of cardiac activity during an extended period of time.
D. The left side of the heart is catheterized first and may be the only side examined.
An alternative to injecting a medium into the coronary arteries is intravascular ultrasonography.
Which statement by the client with a recent cardiovascular diagnosis indicates maladaptive denial?
A. "I don't know how I am going to change my lifestyle."
B. "I don't need to change. It hasn't killed me yet."
C. "I don't think it is as bad as the doctors say."
D. "I will have to change my diet and exercise more."
"I don't need to change. It hasn't killed me yet."
A client who is to undergo cardiac catheterization should be taught which essential information?
A. Monitor the pulses in your feet when you get home.
B. Keep your affected leg straight for at least 8 hours.
C. Do not take your blood pressure medications on the day of the procedure.
D. Take oral hypoglycemic with a sip of water on the morning of the procedure.
Keep your affected leg straight for at least 8 hours.
A client who is suffering dyspnea on exertion and congestive heart failure will likely report which symptom during the health history?
B. Swelling of one leg
C. Awakening at night to urinate
D. Slow heart rate
E. Brown discoloration to lower extremities
Slow heart rate
Which client has the highest risk for cardiovascular disease?
A. Man who smokes and whose father died at 49 from myocardial infarction (MI)
B. Woman with abdominal obesity who exercises three times per week
C. Woman with diabetes whose high-density lipoprotein (HDL) cholesterol is 75
D. Woman who is sedentary who reports four episodes of strep throat
Man who smokes and whose father died at 49 from myocardial infarction (MI)
Which client has pain most consistent with myocardial infarction (MI) requiring notification of the health care provider?
A. A client with abdominal pain and belching
B. A client with pressure in the mid abdomen and profound diaphoresis
C. A client with dyspnea on exertion (DOE) and inability to sleep flat who sleeps on four pillows
D. A client with claudication and fatigue
A client with pressure in the mid abdomen and profound diaphoresis
Which statement best reflects correct client education for a client with a blood pressure (BP) of 134/86?
A. This blood pressure is good because it is a normal reading.
B. This blood pressure indicates that the client has hypertension or high blood pressure.
C. This blood pressure increases the workload of the heart; the client should consider modifying his or her lifestyle.
D. This blood pressure seems a little low; the client should be further assessed for orthostatic hypotension.
This blood pressure increases the workload of the heart; the client should consider modifying his or her lifestyle.
The nurse recognizes that which laboratory findings are consistent with acute coronary syndrome (ACS)? Select all that apply.
A. Troponin 3.2 ng/mL
B. Myoglobin of 234 mcg/L
C. C-reactive protein 13 mg/dL
D. Triglycerides 400 mg/dL
E. Lipoprotein-a (Lp[a]) 18 mg/dL
Troponin 3.2 ng/mL
Myoglobin of 234 mcg/L
Which statement reflects correct cardiac physical assessment technique?
A. Auscultate the aortic valve in the second intercostal space at the right sternal border.
B. Evaluate for orthostatic hypotension by moving the client from a standing to a reclining position.
C. Palpate the apical pulse over the third intercostal space in the midclavicular line.
D. Assess for carotid bruit by auscultating over the anterior neck.
Auscultate the aortic valve in the second intercostal space at the right sternal border.
The client has been admitted to the hospital with chest pain radiating down the left arm. The pain has been unrelieved by rest and antacids. Which test result best confirms that the client sustained a myocardial infarction?
A. C-reactive protein of 1 mg/dL
B. Homocysteine level 13 mmol/L
C. Creatine kinase of 125 mg/dL
D. Troponin of 5.2 ng/mL
Troponin of 5.2 ng/mL
The nurse is caring for a client with hemodynamic monitoring. Right atrial pressure is 2 mm Hg. The nurse anticipates which request by the physician?
A. Saline infusion
B. Morphine sulfate
C. No treatment, continue monitoring
D. Intravenous furosemide
Normal right atrial pressure is 4 to 10 mm Hg; administering saline will restore normal fluid balance.
The nurse is educating a group of clients about risk factors for cardiovascular disease. Which of these risk factors should be included in the discussion?
A. Consuming a diet rich in fiber
B. Elevated C-reactive protein levels
C. Low blood pressure
D. Elevated high-density lipoprotein (HDL) cholesterol level
Elevated C-reactive protein levels
Elevated high-density lipoprotein (HDL) cholesterol level
The nurse is educating a group of women about the differences in symptoms of MI in men versus those in women. Which information should be included?
A. Men do not tend to report chest pain.
B. Men are more likely than women to die after MI.
C. Men more than women tend to deny the importance of symptoms.
D. Women may experience extreme fatigue and dizziness as sole symptoms.
Women may experience extreme fatigue and dizziness as sole symptoms.
The nurse encourages the client to increase his fluid intake after a cardiac catheterization for which reason?
A. NPO status will cause the client to be thirsty.
B. The dye causes an osmotic diuresis.
C. The dye contains a heavy sodium load.
D. The pedal pulses will be more easily palpable.
The dye causes an osmotic diuresis.
The nurse is reviewing the medical record of a client admitted with heart failure. Which of the laboratory results warrants a call to the physician for further instructions?
A. Calcium 8.5 mEq/L
B. Potassium 3.0 mEq/L
C. Magnesium 2.1 mEq/L
D. International normalized ratio (INR) of 1.0
Potassium 3.0 mEq/L
The nurse is teaching a client about the purpose of electrophysiology studies (EPS). Which statement reflects the most correct teaching?
A. This is a noninvasive test performed to assess your heart rhythm.
B. You will receive an injection of dobutamine (Dobutrex) and will walk on a treadmill to reveal whether you have coronary artery disease.
C. This is a painless test that is done to assess the structure of your heart using sound waves.
D. This test evaluates you for potentially fatal cardiac rhythms.
This test evaluates you for potentially fatal cardiac rhythms.
The nurse is caring for a client with suspected pericarditis. Which signs and symptoms support this? Select all that apply.
A. Squeezing, vise-like chest pain
B. Chest pain relieved by sitting upright
C. Chest and abdominal pain relieved by antacids
D. Sudden-onset chest pain relieved by NSAIDs
E. Pain in the chest described as sharp or stabbing
Chest pain relieved by sitting upright
Sudden-onset chest pain relieved by NSAIDs
Pain in the chest described as sharp or stabbing
The nurse is providing education to help reduce cardiovascular risks for adults at a community health fair. Which statement made by a participant indicates understanding of the health education?
A. "I can't do anything about my disease risk because it is in my genes."
B. "I will take my blood pressure medication only when I have symptoms."
C. "I will start walking on the treadmill each day when I watch my favorite TV show."
D. "I don't need to stop smoking because damage to my blood vessels is irreversible."
"I will start walking on the treadmill each day when I watch my favorite TV show."
The nurse is caring for a client with coronary artery disease who has just undergone a coronary angiogram. What is the priority intervention when caring for this client immediately postprocedure?
A. Place the client in high Fowler's to prevent aspiration.
B. Educate the client on anticoagulant medications.
C. Assess for bleeding at the insertion site.
D. Monitor for elevated cardiac enzymes.
Assess for bleeding at the insertion site.
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