quiz 35, 36, 37

1. Which patient 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) a. A patient who has a new diagnosis of heart failure and needs a pulmonary artery catheter inserted

B) b. A patient who has just arrived after a coronary arteriogram and has vital signs requested every 15 minutes

C) c. A patient with acute electrocardiogram changes who is requesting nitroglycerin for left anterior chest pain

D) d. A patient who has many questions about the electrophysiology studies that are scheduled for today

Feedback: CORRECT A 2-month orientation would include the care of patients after arteriograms. The other patients all require more complex assessments or interventions that would be more appropriate for an RN with more experience.These activities are included in the care of the patient who is admitted to the hospital for a cardiac catheterization. Which action should the nurse delegate to experienced unlicensed assistive personnel (UAP) working on the unit?

A) a. Ask the patient about any medications taken before coming to the hospital.

B) b. Have the patient sign the consent form before the procedure.

C) c. Educate the patient about the need to remain on bedrest after the procedure.

D) d. Obtain patient vital signs and a resting electrocardiogram (ECG).

Feedback: CORRECT Vital signs and 12-lead ECGs can be done by UAP. The physician will explain the catheterization procedure and have the patient sign the consent form. Assessment and patient teaching should be done by the RN.Points Earned: 1.0/1.0

Correct Answer(s): D

3. An RN and an LPN/LVN who both have several years of experience in the intensive care unit are caring for a group of patients. Which patient will be appropriate for the RN to assign to the LPN/LVN?

A) a. A patient with pulmonary edema who requires hourly monitoring of pulmonary artery wedge pressures

B) b. A patient who was admitted with peripheral vascular disease and needs assessment of the ankle-brachial index

C) c. A patient who has intermittent chest pain and requires teaching about myocardial nuclear perfusion imaging

D) d. A patient with acute coronary syndrome who has just been admitted and needs an admission assessment

Feedback: CORRECT Ankle-brachial index assessment involves checking the blood pressure at the brachial artery and at the ankle and could be done by an LPN/LVN. The patients with pulmonary edema, chest pain, and acute coronary syndrome are more unstable. In addition, these patients require teaching, hemodynamic monitoring, and an admission assessment, which are complex activities that require RN education and scope of practice.Points Earned: 1.0/1.0

Correct Answer(s): B

4. All of this information is obtained by the nurse who is admitting a patient for a coronary arteriogram. Which information is most important to report to the physician before the procedure begins?

A) a. The patient has had intermittent substernal chest pain for 6 months.

B) b. The patient develops wheezes and dyspnea after eating crab or lobster.

C) c. The patient reports that a previous arteriogram was negative for coronary artery disease.

D) d. The patient has peripheral vascular disease, and the dorsalis pedis pulses are difficult to palpate.

Feedback: CORRECT The contrast agent injected into the coronary arteries during the arteriogram is iodine-based. The patient with a shellfish allergy is likely to have an allergic reaction to the contrast and should be medicated before the procedure with an antihistamine or steroid. The other data will be reported to the physician but do not require any change in the arteriogram procedure.Points Earned: 1.0/1.0


5. A 72-year-old patient admitted with fatigue and dyspnea has elevated levels of all of these laboratory results. Which one should be communicated immediately to the physician?

A) a. White blood cell (WBC) count

B) b. Low-density lipoproteins

C) c. Serum troponin I level

D) d. C-reactive protein

Feedback: CORRECT Elevation in serum troponin levels is associated with acute myocardial injury and indicates a need for immediate interventions such as angioplasty, anticoagulant administration, or administration of fibrinolytic medications. The other laboratory data indicate that the patient is at risk for coronary artery disease but are not indicators of acute problems.Points Earned: 1.0/1.0

Correct Answer(s): C

6. The physician has just requested a transesophageal echocardiogram (TEE) for a patient with possible mitral valve disease. Which action should the nurse take first?

A) a. Auscultate the patient’s precordium for murmurs.

B) b. Teach the patient about the reason for the TEE.

C) c. Reassure the patient that the test is painless.

D) d. Place the patient on NPO status.

Feedback: CORRECT Because a TEE will require that the patient have a transducer passed through the nose and into the esophagus, the patient should be NPO status for several hours before the TEE is done. The nurse will also implement the other actions, but to obtain the TEE as soon as possible, the first action will be the NPO status.Points Earned: 1.0/1.0


7. Which assessment finding for a patient with left ventricular failure who is receiving pulmonary artery pressure (PAP) monitoring indicates a need for rapid action by the nurse?

A) a. The wave form shows that the catheter is continuously in the wedge position.

B) b. The pulmonary artery wedge pressure (PAWP) is 12 to 14 mm Hg.

C) c. The sterile dressing at the catheter insertion site has a bloody area that is 1 cm in size.

D) d. The chest x-ray shows the tip of the catheter in the pulmonary artery.

Feedback: CORRECT Because a pulmonary infarction can occur if the catheter is left in the wedged position, the nurse should have the patient cough and/or change the patient's position. If the catheter remains wedged, the physician should be immediately notified. A slight increase in PAWP and a small amount of bleeding at the catheter insertion site are not unusual. The chest x-ray indicates that the PAP catheter tip is correctly placed.Points Earned: 1.0/1.0

Correct Answer(s): A

by miller, therese (tmiller716) on 4/23/2012 10:28:10 AM

Points Awarded 12.00

Points Missed 0.00

Percentage 100%

1. Recovering from a cardiac angiography, the client begins to slur speech slightly. What does the nurse do first?

A) a. Asks the client to repeat what they saidFeedback: INCORRECT Incorrect: Slurring is a symptom and should be immediately addressed, rather than simply asking the client to repeat her or his words.

B) b. Calls in another nurse for a second opinionFeedback: INCORRECT Incorrect: Be confident in this decision. This assessment doesn't warrant a second opinion.

C) c. Assumes that the client is suffering a neurologic bleed and reacts accordinglyFeedback: CORRECT Correct: Based on this assessment, the client is most probably suffering a neurologic bleed. Neurologic changes, such as visual disturbances, slurred speech, swallowing difficulties, and extremity weakness, should be reported immediately for immediate intervention.

D) d. Nothing; the client is sleepy after this procedure.Feedback: INCORRECT Incorrect: Slurred speech is not normal for this client. A nursing action is needed.

Points Earned: 1.0/1.0


2. The client is a 29-year-old white man who is employed as an accountant. He works an average of 11 hours per day, and reports feeling highly stressed. His father had a massive myocardial infarction at the age of 48, and his mother has congestive heart failure. He seldom has time to exercise, but does eat balanced meals whenever possible, when he has time to eat. Which factors place this client at risk for heart disease? (Select all that apply.)

A) a. AgeFeedback: INCORRECT Incorrect: Age is not a risk factor in this situation.

B) b. StressFeedback: CORRECT Correct: This client reports feeling highly stressed, which is a risk factor for heart disease.

C) c. Family historyFeedback: CORRECT Correct: This client's family history of cardiac problems puts him at risk for developing heart disease.

D) d. LifestyleFeedback: CORRECT Correct: This client reports that he does not exercise. A sedentary lifestyle is a contributing factor for heart disease.

E) e. RaceFeedback: INCORRECT Incorrect: Because the client is white, his race is not a risk factor for heart disease.

F) f. SmokingFeedback: INCORRECT Incorrect: Although smoking is a risk factor for heart disease in general, this client does not claim to smoke.


Correct Answer(s): B, C, D

3. Which statement about diagnostic cardiovascular testing is true?

A) a. A few complications of coronary arteriography include stroke, nonlethal dysrhythmias, arterial bleeding, and thromboembolism.Feedback: INCORRECT Incorrect: Lethal, not nonlethal, dysrhythmias are a complication of diagnostic cardiovascular testing.

B) b. An alternative to injecting a medium into the coronary arteries is intravascular ultrasonography.Feedback: CORRECT Correct: Intravascular ultrasonography is an alternative to the medium injection method of diagnostic cardiovascular testing.

C) c. Halter monitoring allows periodic recording of cardiac activity during an extended period of time.Feedback: INCORRECT Incorrect: Halter monitoring allows periodic recording of cardiac activity during short periods of time.

D) d. The left side of the heart is catheterized first and may be the only side examined.Feedback: INCORRECT Incorrect: Several parts of the heart are examined during diagnostic cardiovascular testing.



4. Which statement by the client with a recent cardiovascular diagnosis indicates maladaptive denial?

A) a. ''I don't know how I am going to change my lifestyle.''Feedback: INCORRECT Incorrect: This statement indicates that the client is overwhelmed, not in denial.

B) b. ''I don't need to change. It hasn't killed me yet.''Feedback: CORRECT Correct: This statement indicates maladaptive denial.

C) c. ''I don't think it is as bad as the doctors say.''Feedback: INCORRECT Incorrect: This statement indicates denial, but not maladaptive denial.

D) d. ''I will have to change my diet and exercise more.''Feedback: INCORRECT Incorrect: This statement does not indicate denial, but a willingness to change.



5. Which statement about the anatomy and physiology of the heart is true?

A) a. The heart is encapsulated by a protective coating called the endocardium.Feedback: INCORRECT Incorrect: The protective coating encapsulating the heart is called the pericardium.

B) b. The left atrium receives deoxygenated venous blood from all peripheral tissues.Feedback: INCORRECT Incorrect: The right atrium receives deoxygenated blood from the peripheral tissues.

C) c. Stroke volume is the amount of blood ejected by the right ventricle during each diastole.Feedback: INCORRECT Incorrect: Stroke volume is the amount of blood ejected by the left ventricle.

D) d. The sinoatrial (SA) node is considered the main regulator of heart rate.Feedback: CORRECT Correct: The main regulator of the heart is the SA node.



6. The 74-year-old client is suffering from chest tightness, dyspnea on exertion, and congestive heart failure. Which physiologic cardiovascular change is related to the client's age?

A) a. Baroreceptors become more sensitiveFeedback: INCORRECT Incorrect: Baroreceptors actually become less sensitive with age.

B) b. Conduction time decreasesFeedback: INCORRECT Incorrect: Conduction time increases with age.

C) c. Systolic blood pressure decreases to compensate for stiff arteriesFeedback: INCORRECT Incorrect: Systolic blood pressure increases with age.

D) d. Systemic vascular resistance increasesFeedback: CORRECT Correct: Systemic vascular resistance increases with age.



7. Which client has the highest risk for cardiovascular disease?

A) a. Man who smokes and has had a vasectomyFeedback: INCORRECT Incorrect: Tobacco use is a risk for cardiovascular disease, but the vasectomy is not.

B) b. Woman who smokes and exercises 3 times per weekFeedback: INCORRECT Incorrect: Tobacco use is a risk for cardiovascular disease, but regular and consistent exercise is not.

C) c. Woman who smokes and uses oral contraceptivesFeedback: CORRECT Correct: There is an increased incidence of myocardial infarction and stroke in women who take oral contraceptives, but only if they smoke, have diabetes, or have hypertension.

D) d. Woman who smokes and has had a tubal ligationFeedback: INCORRECT Incorrect: Tobacco use is a risk for cardiovascular disease, but the tubal ligation is not.



8. Which statement referring to a complete cardiac examination is true?

A) a. A client no longer has hypertension if it is controlled by medication.Feedback: INCORRECT Incorrect: A client who takes medication to control hypertension is still considered to have hypertension.

B) b. Orthostatic hypertension is measured when a person moves from a standing to reclining position.Feedback: INCORRECT Incorrect: Orthostatic hypertension is measured when a person moves from a reclining to standing position.

C) c. The apical pulse is palpated over the third intercostal space in the midclavicular line.Feedback: INCORRECT Incorrect: The apical pulse is palpated over the fifth intercostal space in the midclavicular line.

D) d. The carotid artery on the neck is auscultated to assess for the presence of a bruit.Feedback: CORRECT Correct: A bruit is assessed by auscultating the carotid artery on the neck.



9. The client has been admitted to the hospital with an 8-hour history of chest pain radiating down the left arm and around to the shoulder blade. The pain has been unrelieved by rest and the use of antacids. Which test result confirms the presence of cardiovascular disease?

A) a. C-reactive protein lower than 1 mg/dLFeedback: INCORRECT Incorrect: A C-reactive protein level lower than 1 mg/dL is optimal.

B) b. Homocysteine level lower than 12 mmol/dLFeedback: INCORRECT Incorrect: A homocysteine level lower than 12 mmol/dL is optimal.

C) c. Absence of myoglobinFeedback: INCORRECT Incorrect: The absence of myoglobin levels is desirable.

D) d. Presence of troponinFeedback: CORRECT Correct: The presence of troponin indicates cardiovascular damage.



10. A client in the intensive care unit is being hemodynamically monitored. The right atrial pressure is low. What does this value indicate?

A) a. HypovolemiaFeedback: CORRECT Correct: Low right atrial pressure usually indicates hypovolemia.

B) b. Mitral regurgitationFeedback: INCORRECT Incorrect: Mitral regurgitation is indicated by pulmonary artery wedge pressure.

C) c. Normal functionFeedback: INCORRECT Incorrect: A low right atrial pressure is not normal.

D) d. Right ventricular failureFeedback: INCORRECT Incorrect: A high right atrial pressure would indicate right ventricular failure.

Submitted by miller, therese (tmiller716) on 4/23/2012 10:41:28 AM

Points Awarded 9.00

Points Missed 0.00

Percentage 100%

1. Situation: Your patient is a 68-year-old man who presented to the emergency department complaining of chest pain. His initial monitored rhythm was a sinus tachycardia with frequent premature ventricular complexes (PVCs). He moans, and the monitor shows ventricular fibrillation (VF). He is defibrillated, and a dose of vasopressin (Pitressin) is administered. He remains in VF. He is given a dose of amiodarone (Cordarone). His rhythm converts to a sinus tachycardia after another defibrillation attempt. Amiodarone (Cordarone) is a Vaughn-Williams class III antidysrhythmic medication. What is your understanding of the way this class of medication functions?

A) a. They compete for beta-adrenergic sites.

B) b. They are membrane-stabilizing agents.

C) c. They lengthen the absolute refractory period.

D) d. They impede the flow of calcium into the cell during depolarization.

Feedback: CORRECT p. 751 They also prolong repolarization and the action potential duration of ischemic cells.Points Earned: 1.0/1.0


2. Situation: Your patient is a 68-year-old man who presented to the emergency department complaining of chest pain. His initial monitored rhythm was a sinus tachycardia with frequent premature ventricular complexes (PVCs). He moans, and the monitor shows ventricular fibrillation (VF). He is defibrillated, and a dose of vasopressin (Pitressin) is administered. He remains in VF. He is given a dose of amiodarone (Cordarone). His rhythm converts to a sinus tachycardia after another defibrillation attempt. He is placed on an amiodarone (Cordarone) IV infusion. Why must you monitor heart rate, QT interval, and blood pressure?

A) a. Tachycardia may occur.

B) b. Hypertension may occur.

C) c. Bradycardia and AV block may occur.

D) d. QT interval may shorten.

Feedback: CORRECT pp. 741-745, Chart 36-2 Class III antidysrhythmics lengthen the absolute refractory period and prolong repolarization and the action potential duration of ischemic cells.



3. Situation: Your patient is a 68-year-old man who presented to the emergency department complaining of chest pain. His initial monitored rhythm was a sinus tachycardia with frequent premature ventricular complexes (PVCs). The patient moans, and the monitor shows ventricular fibrillation (VF). He is defibrillated, and a dose of vasopressin (Pitressin) is administered. He remains in VF. He is given a dose of amiodarone (Cordarone). His rhythm converts to a sinus tachycardia after another defibrillation attempt. He survives and is discharged to home on a beta blocker, propranolol hydrochloride (Inderal). Why do you want to monitor this patient for wheezing?

A) a. The medication can send him into a flash pulmonary edema.

B) b. He is at risk for development of a nosocomial lung infection.

C) c. His cardiac output has been severely compromised as a result of the ventricular fibrillation.

D) d. The beta2-blocking effects on the lungs can cause bronchospasm.

Feedback: CORRECT pp. 741-745, Chart 36-2 See answer.Points Earned: 1.0/1.0


4. Situation: Your patient is a 68-year-old man who presented to the emergency department complaining of chest pain. His initial monitored rhythm was a sinus tachycardia with frequent premature ventricular complexes (PVCs). He moans, and the monitor shows ventricular fibrillation (VF). He is defibrillated, and a dose of vasopressin (Pitressin) is administered. He remains in VF. He is given a dose of amiodarone (Cordarone). His rhythm converts to a sinus tachycardia after another defibrillation attempt. Although he was in sinus rhythm for a short period, he is now exhibiting atrial fibrillation. What medication do you expect to be prescribed?

A) a. Ibutilide fumarate (Covert)

B) b. Atropine

C) c. Adenosine (Adenocard)

D) d. Magnesium sulfate

Feedback: CORRECT

pp. 741-745, Chart 36-2 Ibutilide fumarate is used for atrial flutter and fibrillation. Stop the infusion as soon as dysrhythmia is terminated or marked prolongation of QT interval occurs. The drug may cause potentially fatal dysrhythmias.Points Earned: 1.0/1.0


5. Situation: Your patient is a 68-year-old man who presented to the emergency department complaining of chest pain. His initial monitored rhythm was a sinus tachycardia with frequent premature ventricular complexes (PVCs). He moans, and the monitor shows ventricular fibrillation (VF). He is defibrillated, and a dose of vasopressin (Pitressin) is administered. He remains in VF. He is given a dose of amiodarone (Cordarone). His rhythm converts to a sinus tachycardia after another defibrillation attempt. His cardiac rhythm has returned to normal sinus rhythm, and he is being discharged home on a beta blocker (propranolol hydrochloride [Inderal]), propafenone hydrochloride (Rythmol), and aspirin. What education should you give to this patient concerning propranolol (Inderal)? Select all that apply.

A) a. Monitor heart rate and blood pressure.

B) b. Increase fluid intake.

C) c. Be aware that this medication can cause fatigue and insomnia.

D) d. Monitor urine output.

Feedback: CORRECT pp. 741-745, Chart 36-2 Inderal may cause bradycardia and decreased blood pressure. It may also cause insomnia, fatigue, and dizziness.Points Earned: 2.0/2.0

Correct Answer(s): A, C

6. Situation: Your patient is a 68-year-old man who presented to the emergency department complaining of chest pain. His initial monitored rhythm was a sinus tachycardia with frequent premature ventricular complexes (PVCs). He moans, and the monitor shows ventricular fibrillation (VF). He is defibrillated, and a dose of vasopressin (Pitressin) is administered. He remains in VF. He is given a dose of amiodarone (Cordarone). His rhythm converts to a sinus tachycardia after another defibrillation attempt. His cardiac rhythm has returned to normal sinus rhythm, and he is being discharged home on a beta blocker (propranolol hydrochloride [Inderal]), propafenone hydrochloride (Rythmol), and aspirin. What education should you give this patient concerning propafenone hydrochloride (Rythmol)? Select all that apply.

A) a. He needs to monitor heart rate and blood pressure.

B) b. He will need to monitor for dysrhythmias.

C) c. He may experience confusion and insomnia.

D) d. He will need to monitor his blood glucose.

Feedback: CORRECT pp. 741-745, Chart 36-2Points Earned: 3.0/3.0

Correct Answer(s): A, B, C


Points Awarded 5.00

Points Missed 0.00

Percentage 100%

1. You are the charge nurse on the telemetry unit and are responsible for making patient assignments. Which patient would be appropriate to assign to the float RN from the medical-surgical unit?

A) a. The 64-year-old admitted for weakness who has a first-degree heart block with a heart rate of 58 beats/min

B) b. The 71-year-old admitted for heart failure who is short of breath and has a heart rate of 120 to 130 beats/min

C) c. The 88-year-old admitted with an elevated troponin level who is hypotensive with a heart rate of 96 beats/min

D) d. The 92-year-old admitted with chest pain who has premature ventricular complexes and a heart rate of 102 beats/min

Feedback: CORRECT

This patient has a stable dysrhythmia with minimal clinical manifestations and can be managed by a nurse with less cardiac dysrhythmia training. The other patients are less stable and should be cared for by nurses with experience in caring for patients on the telemetry unit.Points Earned: 1.0/1.0


2. You are caring for a patient with atrial flutter who has a ventricular rate of 128 who is scheduled for synchronized cardioversion. Which action can you direct the LPN/LVN to implement?

A) a. Titrate the oxygen flow rate to keep O2 saturation at 95%.

B) b. Infuse normal saline IV at 100 mL/hr.

C) c. Teach the patient about the planned cardioversion.

D) d. Monitor the patient during and after cardioversion.

Feedback: CORRECT LPN/LVN scope of practice includes administration and monitoring of oxygen. Although administration of IV fluids may sometimes be included in LPN/LVN scope of practice, the RN should monitor IV infusion in this patient who is at risk for fluid overload because of the dysrhythmia. Teaching and monitoring a potentially unstable patient during and after cardioversion should also be done by the RN.Points Earned: 1.0/1.0


3. A patient in the emergency department whose cardiac monitor shows atrial fibrillation at 110 beats/min complains of feeling weak "for the last month." The patient's blood pressure is 112/76. Which action will the nurse anticipate implementing next?

A) a. Prepare for synchronized cardioversion.

B) b. Refer for electrophysiology studies (EPS).

C) c. Teach the patient about anticoagulant use.

D) d. Admit for radiofrequency ablation therapy.

Feedback: CORRECT Because the patient is stable, anticoagulant therapy is indicted for several weeks before attempting to convert this rhythm with cardioversion. Synchronized cardioversion might be done if the patient was unstable, but this would subject the patient to complications caused by possible embolization. EPS or ablation therapy is ordered for recurring and symptomatic atrial fibrillation.Points Earned: 1.0/1.0


4. The nurse is caring for a patient with unstable angina whose cardiac monitor shows ventricular tachycardia. What action is appropriate to implement first?

A) a. Defibrillate the patient at 200 J.

B) b. Check the patient for a pulse.

C) c. Cardiovert the patient at 50 J.

D) d. Give the patient IV lidocaine.

Feedback: CORRECT The nurse needs to assess the patient to determine stability before proceeding with further interventions. If the patient has a pulse and is relatively stable, elective cardioversion or antidysrhythmic medications may be prescribed. If the patient is pulseless or nonresponsive, defibrillation will be immediately implemented.Points Earned: 1.0/1.0


5. The monitor for a patient who was admitted after using crack cocaine shows sinus tachycardia that suddenly changes to ventricular fibrillation. After determining that the patient is unresponsive, which action should the nurse take next?

A) a. Defibrillate at 200 J.

B) b. Establish IV access.

C) c. Place an oral airway and ventilate.

D) d. Start cardiopulmonary resuscitation.

Feedback: CORRECT Defibrillating is of priority before any other resuscitative measures according to Advanced Cardiac Life Support protocols. The other actions may be needed if defibrillation is ineffective in restoring a more normal rhythm.Points Earned: 1.0/1.0




Points Missed 0.00

Percentage 100%

1. In the intensive care unit, the nurse finds the client in ventricular tachycardia. What does the nurse do first?

A) a. Defibrillates the client immediatelyFeedback: INCORRECT Incorrect: The client must be defibrillated, but this is not the best answer.

B) b. Assesses the carotid pulseFeedback: CORRECT Correct: Assessing the carotid pulse would be done after checking the client's airway, breathing, circulation, level of consciousness, and oxygenation status to determine whether ventricular tachycardia is stable or unstable. If a pulse is present, it is stable, and synchronized cardioversion is recommended.

C) c. Starts CPR (cardiopulmonary resuscitation)Feedback: INCORRECT Incorrect: CPR is not the best action to take if a defibrillator is available.

D) d. Performs synchronized cardioversion on the clientFeedback: INCORRECT Incorrect: Synchronized cardioversion is recommended for stable ventricular tachycardia.



2. The client diagnosed with dysrhythmia is being discharged with a prescription for digoxin (Lanoxin). What does the nurse tell the client about this medication?

A) a. ''Call your doctor if your heart rate is less than 100 beats/min.''Feedback: INCORRECT Incorrect: The health care provider should be notified if the heart rate is less than 60 betas/min. This could be a sign of toxicity.

B) b. ''Take the digoxin with 8 ounces of water.''Feedback: INCORRECT Incorrect: It is not necessary to take digoxin with 8 ounces of water.

C) c. ''It is okay to skip a dose.''Feedback: INCORRECT Incorrect: Clients taking digoxin should never skip a dose.

D) d. ''Take the digoxin the same time every day.''Feedback: CORRECT Correct: Digoxin should be taken at the same time every day.



3. In teaching clients at risk for bradydysrhythmias, what information does the nurse include?

A) a. ''Eat foods high in potassium.''Feedback: INCORRECT Incorrect: Clients at risk for potassium imbalance would be instructed to eat foods high in potassium.

B) b. ''Stop smoking and avoid caffeine.''Feedback: INCORRECT Incorrect: Clients at risk of premature beats and ectopic rhythms would be instructed to stop smoking and avoid caffeine.

C) c. ''Take nitroglycerin for a slow heartbeat.''Feedback: INCORRECT Incorrect: Clients with ischemic heart disease would take nitroglycerin for a slow heartbeat.

D) d. ''Use a stool softener.''Feedback: CORRECT Correct: Clients at risk for bradydysrhythmias should avoid bearing down or straining during a bowel movement. Taking a stool softener helps prevent this.



4. The client is a 78-year-old man admitted to the step-down cardiothoracic unit following a coronary bypass graft. He is sitting up visiting with his family in a room by the nurse's station, when he suddenly falls back in bed. His rhythm strip shows ventricular tachycardia. Which action does the nurse take first?

A) a. Administers a precordial thump as the emergency equipment arrivesFeedback: CORRECT Correct: The nurse should administer a precordial thump and then defibrillate the client.

B) b. Administers an asynchronous countershock at 100 joulesFeedback: INCORRECT Incorrect: Administering an asynchronous countershock would be inappropriate.

C) c. Prepares the client for radiofrequency catheter ablationFeedback: INCORRECT Incorrect: Preparing the client for radiofrequency catheter ablation is not the priority in this scenario.

D) d. Prepares to administer 50 joules as a synchronized countershockFeedback: INCORRECT Incorrect: Administering a synchronized countershock to this client would be inappropriate.



5. The client is admitted into the intensive care unit for continuous electrocardiogram (ECG) monitoring. What does the nurse do to prepare the client?

A) a. Instructs the client to lie still and not talkFeedback: INCORRECT

Incorrect: The client should lie still and not talk during an ECG procedure, not continuous ECG monitoring.

B) b. Places gel on the left anterior chest wall regionFeedback: INCORRECT Incorrect: Gel is applied to the chest wall for an echocardiogram.

C) c. Uses a three- or five-electrode cable systemFeedback: CORRECT Correct: A three- or five-electrode cable system is appropriate for continuous monitoring to avoid noise or motion artifact.

D) d. Applies two leads to the lower legsFeedback: INCORRECT Incorrect: Leads should be placed on the trunk to minimize artifacts and to create a clearer signal.



6. In the telemetry unit, the client's morning rhythm strip shows a heart rate of 76 beats/min, one p wave occurring before each QRS complex, a PR interval measuring 0.24 second, and a QRS complex measuring 0.08 second. What is the correct interpretation of this rhythm strip?

A) a. Normal sinus rhythmFeedback: INCORRECT Incorrect: A normal sinus rhythm would show a PR interval shorter than 0.20 second.

B) b. Sinus bradycardiaFeedback: INCORRECT Incorrect: A heart rate of less than 60 beats/min would indicate sinus bradycardia.

C) c. Sinus rhythm with first-degree atrioventricular (AV) blockFeedback: CORRECT Correct: The data indicates sinus rhythm with first-degree AV block.

D) d. Sinus rhythm with premature ventricular contractionsFeedback: INCORRECT Incorrect: Early QRS intervals would indicate sinus rhythm with premature ventricular contractions.



7. The client being monitored to rule out myocardial infarction reports chest pain and has a sinus tachycardia. After administrating oxygen, what does the nurse do next?

A) a. Administers nitroglycerinFeedback: CORRECT Correct: Typically, standing drug therapy orders would be provided for a client in this scenario.

B) b. Ambulates the clientFeedback: INCORRECT Incorrect: Ambulating this client would be contraindicated.

C) c. Calls the health care providerFeedback: INCORRECT Incorrect: Calling the health care provider is not necessary if appropriate precautionary measures have been taken.

D) d. Gives diureticsFeedback: INCORRECT Incorrect: Diuretics are not indicated for this client.



8. The client admitted to the step-down unit following cardiac bypass surgery has a history of CHF, HTN, NIDDM, and hypothyroidism. The rhythm strip upon admission to the step-down unit shows normal sinus rhythm. Two hours after transfer, the client's rhythm strip shows no visible P waves and 16 QRS complexes. Which type of pacing is appropriate for this client?

A) a. Atrial overdriveFeedback: CORRECT Correct: This client is exhibiting atrial tachycardia for which atrial overdrive pacing is indicated.

B) b. Fixed-rateFeedback: INCORRECT Incorrect: Fixed-rate pacing is indicated for asystole or severe bradycardia.

C) c. Non-invasive temporaryFeedback: INCORRECT Incorrect: Non-invasive temporary pacing is indicated for asystole or severe bradycardia.

D) d. No pacing; defibrillation is indicated.Feedback: INCORRECT Incorrect: Pacing, not defibrillation, is indicated for this client.



9. The nurse is changing a dressing around a temporary pacemaker site. To insulate the unconnected lead wires, what does the nurse use?

A) a. Nonconductive tapeFeedback: INCORRECT Incorrect: Nonconductive tape is not an insulation.

B) b. The pacemakerFeedback: INCORRECT Incorrect: The unconnected lead wires indicate that the pacemaker has not been implanted yet.

C) c. Tips of rubber glovesFeedback: CORRECT Correct: The fingertips of rubber gloves work well to insulate the wire ends to prevent microshock. The wire ends may then be looped and covered with nonconductive tape.

D) d. Sterile tinfoilFeedback: INCORRECT Incorrect: Sterile tinfoil is a conductor and contraindicated.



10. The client in the intensive care unit is found pulseless and unresponsive in bed. After calling for help, what does the responding nurse do next?

A) a. Gets the ''crash cartFeedback: INCORRECT Incorrect: The emergency cardiac team or another staff member should bring the crash cart.

B) b. DefibrillatesFeedback: INCORRECT Incorrect: Defibrillating the client is the immediate priority.

C) c. Ensures that IV access is in placeFeedback: INCORRECT Incorrect: Attending to IV access is not the priority in this scenario.

D) d. Starts CPRFeedback: CORRECT Correct: After calling for help, this is the first priority of the responding nurse.



11. The nurse is teaching the client with a new permanent pacemaker. Which statement by the client indicates the need for further discharge education?

A) a. ''I will be able to shower again soon.''Feedback: INCORRECT Incorrect: Once the wound from the surgery heals, the client will be able to shower.

B) b. ''I need to take my pulse every day.''Feedback: INCORRECT Incorrect: The client's pulse will need to be taken and recorded for 1 full minute at the same time each day.

C) c. ''I might trigger airport security metal detectors.''Feedback: INCORRECT Incorrect: The metal in the pacemaker will trigger the alarm in metal detector devices. A card can be shown to authorities to indicate the client has a pacemaker.

D) d. ''I no longer need my heart pills.''Feedback: CORRECT Correct: All discharge medications are still needed after the pacemaker is implanted.





Points Missed 0.00

Percentage 100%

1. Situation: Your patient is a 78-year-old woman with heart failure from left ventricular dysfunction. She is admitted to your unit with complaints of increasing shortness of breath and increased fatigue and dizziness. Her medications include digoxin (Lanoxin) and furosemide (Lasix). Her health care provider has started her on an angiotensin-converting enzyme (ACE) inhibitor. Her admission blood pressure is 98/56 with a heart rate of 63. You are about to administer her daily dose of digoxin. Her heart rate is 48 and irregular. A potassium level of 3.6 is noted on her chart. What action should you take?

A) a. Give the digoxin, and reassess her heart rate.

B) b. Give the digoxin, and document her cognitive status.

C) c. Hold the digoxin, and obtain a prescription for an additional dose of furosemide.

D) d. Hold the digoxin, report the irregular heart rate, and obtain a prescription for potassium supplement.

Feedback: CORRECT p. 773 Report the irregular heart rate; hypokalemia potentiates digitalis toxicity.Points Earned: 1.0/1.0


2. Situation: Your patient is a 78-year-old woman with heart failure from left ventricular dysfunction. She is admitted to your unit with complaints of increasing shortness of breath and increased fatigue and dizziness. Her medications include digoxin (Lanoxin) and furosemide (Lasix). Her health care provider has started her on an angiotensin-converting enzyme (ACE) inhibitor. Her admission blood pressure is 98/56 with a heart rate of 63. She is doing well and getting ready to go home. Her medications will include digoxin (Lanoxin), furosemide (Lasix), and an angiotensin-converting enzyme inhibitor. What should concern you about a patient taking furosemide?

A) a. This medication can increase serum sodium.

B) b. This medication can increase serum potassium

C) c. This medication can decrease serum potassium.

D) d. This medication can decrease serum sodium.

Feedback: CORRECT p. 778 Patients taking loop diuretics should monitor for potassium deficiency from diuretic therapy.Points Earned: 1.0/1.0


3. Situation: Your patient is a 78-year-old woman with heart failure from left ventricular dysfunction. She is admitted to your unit with complaints of increasing shortness of breath and increased fatigue and dizziness. Her medications include digoxin (Lanoxin) and furosemide (Lasix). Her health care provider has started her on an angiotensin-converting enzyme (ACE) inhibitor. Her admission blood pressure is 98/56 with a heart rate of 63. She is doing well and getting ready to go home. Her medications will include digoxin (Lanoxin), furosemide (Lasix), and an angiotensin-converting enzyme inhibitor. What should she monitor specific to taking furosemide once discharged?

A) a. Monitor fluid intake.

B) b. Monitor serum glucose.

C) c. Monitor heart rate.

D) d. Monitor fluid output.

Feedback: CORRECT p. 772 Diuretics can cause dehydration, especially in older adults. Observe for acute confusion and decreased urinary output.Points Earned: 1.0/1.0


4. Situation: Your patient is a 78-year-old woman with heart failure from left ventricular dysfunction. She is admitted to your unit with complaints of increasing shortness of breath and increased fatigue and dizziness. Her medications include digoxin (Lanoxin) and furosemide (Lasix). Her health care provider has started her on an angiotensin-converting enzyme (ACE) inhibitor. Her admission blood pressure is 98/56 with a heart rate of 63. What should be considered at the start of ACE inhibitor therapy? Select all that apply.

A) a. The patients ability to understand medication teaching�B) b. The risk for hypotension

C) c. The potential for orthostatic hypotension

D) d. Liver function tests (LFTs)

Feedback: CORRECT p. 772 The first dose of an ACE inhibitor is sometimes associated with a rapid drop in blood pressure. Patients at risk have initial systolic blood pressures less than 100 mm Hg or are older than 75 years. Assess patients for orthostatic hypotension.Points Earned: 3.0/3.0


5. Situation: Your patient is a 78-year-old woman with heart failure from left ventricular dysfunction. She is admitted to your unit with complaints of increasing shortness of breath and increased fatigue and dizziness. Her medications include digoxin (Lanoxin) and furosemide (Lasix). Her health care provider has started her on an angiotensin-converting enzyme (ACE) inhibitor. Her admission blood pressure is 98/56 with a heart rate of 63. Patients receiving diuretic therapy with Lasix should be monitored for what potential complications? Select all that apply.

A) a. Hyperkalemia

B) b. Hypokalemia

C) c. Dehydration

D) d. Weight gain

Feedback: CORRECT p. 772 Monitor for and prevent potassium deficiency. Older patients receiving loop diuretics are susceptible to dehydration.Points Earned: 2.0/2.0

Correct Answer(s): B, C

6. Situation: Your patient is a 78-year-old woman with heart failure from left ventricular dysfunction. She is admitted to your unit with complaints of increasing shortness of breath and increased fatigue and dizziness. Her medications include digoxin (Lanoxin) and furosemide (Lasix). Her health care provider has started her on an angiotensin-converting enzyme (ACE) inhibitor. Her admission blood pressure is 98/56 with a heart rate of 63. She is doing well and getting ready to go home. Her medications will include digoxin (Lanoxin), furosemide (Lasix), and an angiotensin-converting enzyme inhibitor. How does digoxin help patients who have heart failure? Select all that apply.

A) a. Increased cardiac contractility

B) b. Reduced heart rate

C) c. Decreased electrical conduction through the atrioventricular node

D) d. Increased sympathetic stimulation to the heart and blood vessels

Feedback: CORRECT p. 773 The potential benefits of digoxin include increased contractility, reduced heart rate, slowing of conduction through the atrioventricular node, and inhibition of sympathetic activity while enhancing parasympathetic activity.Points Earned: 3.0/3.0



Points Awarded 8.00

Points Missed 0.00

Percentage 100%

1. The telemetry unit is staffed with three RNs from the float pool and one RN who is regularly scheduled on the telemetry unit. Which patient should be assigned to the telemetry RN?

A) a. The 49-year-old with mitral valve stenosis who is scheduled for balloon valvuloplasty the following day

B) b. The 57-year-old with dilated cardiomyopathy who has been started on carvedilol (Coreg) therapy

C) c. The 62-year-old who was cardioverted for supraventricular tachycardia and is in sinus rhythm, rate 62

D) d. The 75-year-old who was admitted for left ventricular failure and is receiving a dobutamine (Dobutrex) infusion

Feedback: CORRECT This patient's diagnosis and treatment with dobutamine indicate the need for assessments and interventions by a nurse familiar with the care of hemodynamically unstable patients. The other patients are more stable and can be cared for by the float nurses.Points Earned: 1.0/1.0


2. Which of these patients is best to assign to an LPN/LVN working on the telemetry unit?

A) a. A patient with heart failure who is receiving nesiritide (Natrecor)

B) b. A patient with restrictive cardiomyopathy who uses oxygen for exertional dyspnea

C) c. A patient with pericarditis who has a paradoxical pulse and distended jugular veins

D) d. A patient with rheumatic fever who has a new systolic murmur

Feedback: CORRECT This patient who needs oxygen only with exertion is the most stable of the four patients, and administration of oxygen to a stable patient is within the scope of LPN/LVN practice. The information about the other patients indicates that they are less stable and should receive assessments and interventions by an RN.Points Earned: 1.0/1.0


3. After receiving change-of-shift report about these four patients, which patient should the nurse assess first?

A) a. The 46-year-old with aortic stenosis who takes digoxin (Lanoxin) and has new-onset frequent premature ventricular complexes

B) b. The 55-year-old admitted with pulmonary edema who received furosemide (Lasix) and whose current O2 saturation is 94%

C) c. The 68-year-old with pericarditis who is complaining of a sharp, stabbing chest pain when taking deep breaths

D) d. The 79-year-old admitted for possible rejection of a heart transplant who has sinus tachycardia, rate 104

Feedback: CORRECT This patient's premature ventricular complexes may be indicative of digoxin toxicity. Further assessment for clinical manifestations of digoxin toxicity should be done and the physician notified about the dysrhythmia. The other patients also should be assessed as soon as possible but do not appear to have complications that need immediate intervention.Points Earned: 1.0/1.0


4. When caring for a patient who has undergone a partial left ventriculectomy, which of these new-onset clinical manifestations indicates a need for immediate action by the nurse?

A) a. Chest pain with movement

B) b. Fatigue after ambulation

C) c. Muffled heart sounds

D) d. Bi-basilar fine crackles

Feedback: CORRECT This patient's muffled heart sounds may be a clinical manifestation of bleeding into the pericardial space; the nurse should assess the patient for possible decreased cardiac output and notify the surgeon. The other assessment data are common after chest surgery, although the nurse should intervene to correct these problems.Points Earned: 1.0/1.0


5. A patient admitted for heart failure has a nursing diagnosis of Excess Fluid Volume related to compromised regulatory mechanisms. Which of these assessment data the day after admission is the best indicator that the treatment has been effective?

A) a. The patient has a diuresis of 2000 mL in 24 hours.

B) b. The patient’s blood pressure is 122/84 mm Hg.

C) c. The patient has an apical pulse of 82 beats/min.

D) d. The patient’s weight decreases by 2.5 kilograms.

Feedback: CORRECT The best indicator of fluid volume loss is daily weight. The other parameters also may indicate that the patient's status is improving, but assessment of daily weight will provide the best information for this nursing diagnosis.Points Earned: 1.0/1.0


6. The physician writes these orders for a patient admitted with pulmonary edema. Which order should the nurse implement first?

A) a. Provide 100% oxygen per non-rebreather mask.

B) b. Give furosemide (Lasix) 100 mg IV.

C) c. Infuse nitroglycerin (Tridil) at 5 mcg/kg/min.

D) d. Administer morphine sulfate 2 mg IV.

Feedback: CORRECT The first priority is to improve oxygenation by administration of high-flow oxygen. The other orders should also be implemented rapidly, but oxygen administration is the first action.Points Earned: 1.0/1.0


7. The home health nurse visits a patient with heart failure who has gained 5 pounds in the past 3 days and who says, "I feel so tired and short of breath." Which action should the nurse take first?

A) a. Assess the patient for any peripheral edema.

B) b. Listen to the patient’s posterior breath sounds.

C) c. Notify the physician about the patient’s weight gain.

D) d. Remind the patient about dietary sodium restrictions.

Feedback: CORRECT

Further assessment is needed before any intervention is implemented. Because the patient is at risk for pulmonary edema and hypoxemia, the first action should be to assess breath sounds. Next, the nurse should assess for peripheral edema and ask the patient about behaviors that may have caused the weight gain such as increased sodium intake or changes in medications. Finally, the nurse should notify the physician.Points Earned: 1.0/1.0


8. Which of these nursing actions should the nurse delegate to a nursing assistant working on the medical unit?

A) a. Determine the usual alcohol intake for a patient with cardiomyopathy.

B) b. Monitor the pain level for a patient with acute pericarditis.

C) c. Obtain the daily weights for several patients with class IV heart failure.

D) d. Check for peripheral edema on a patient with endocarditis.

Feedback: CORRECT Daily weight assessment is included in the role for the nursing assistant, who will report the weights to the RN. The other actions require the education and scope of practice of licensed nursing staff.Points Earned: 1.0/1.0




Points Missed 0.00

Percentage 100%

1. The client admitted to the hospital with end-stage heart disease has no written advanced directives. What does the nurse do?

A) a. Calls the hospital ethics departmentFeedback: INCORRECT Incorrect: Calling the hospital ethics department is inappropriate.

B) b. Instructs the family to obtain themFeedback: INCORRECT Incorrect: It is appropriate to include the family in the discussion, but instructing the family to obtain advanced directives for the client is inappropriate.

C) c. Nothing; it is the client's right to not have them.Feedback: INCORRECT Incorrect: The client may not be aware of the importance of advance directives. The nurse must take action to rectify this.

D) d. Provides information about themFeedback: CORRECT Correct: The nurse should provide information to the client about the importance of advance directives.



2. The nurse is providing discharge education for the client going home after a hospital admission for heart failure. Which statement by the client indicates a need for further instruction?

A) a. ''I need to drink fewer liquids.''Feedback: INCORRECT Incorrect: Fluid intake should be limited to 2 L per day for this client.

B) b. ''I must eat less salt.''Feedback: INCORRECT Incorrect: Sodium intake for this client should be limited to 2 to 3 g per day as prescribed.

C) c. ''I need to start jogging every day.''Feedback: CORRECT Correct: The client should stay as active as possible, but should not overdo it with daily jogging.

D) d. ''I must stop taking Motrin.''Feedback: INCORRECT Incorrect: This client should avoid taking NSAIDs.



3. The older adult client with cardiac failure is being discharged. The client's activity is severely limited and the family does not appear to have the resources to support the client's care. What does the nurse do?

A) a. Calls a long-term care facilityFeedback: INCORRECT Incorrect: Calling a long-term care facility on this client's behalf would be inappropriate in this situation.

B) b. Contacts a case manager, if availableFeedback: CORRECT Correct: In this case, contacting a case manager is the best course of action.

C) c. Continues the discharge as orderedFeedback: INCORRECT Incorrect: If the nurse continued the discharge, he or she would fail in the role of being a client advocate.

D) d. Delays the dischargeFeedback: INCORRECT Incorrect: Discharge cannot be delayed. The bed is usually needed by other incoming clients.



4. The client with cardiac failure is being discharged. The client's spouse asks the nurse where to get more information on lifestyle and dietary modification. What does the nurse recommend?

A) a. American Heart AssociationFeedback: CORRECT

Correct: The American Heart Association is an excellent community resource for pamphlets, books, cookbooks, and videotapes related to HF and heart disease. The organization also provides referrals to various local support groups for clients and their caregivers.

B) b. American Lung AssociationFeedback: INCORRECT Incorrect: The American Lung Association is not the most appropriate resource for this client's situation.

C) c. Hospital dieticianFeedback: INCORRECT Incorrect: Consulting with the hospital nutritionist is not usually an option.

D) d. PhysicianFeedback: INCORRECT Incorrect: Consulting with the physician is not the best suggestion.



5. While assessing the newly admitted client with heart failure, which sign or symptom indicates that emergency action is needed?

A) a. Expectorating frothy, pink-tinged sputumFeedback: CORRECT Correct: The expectoration of frothy, pink-tinged sputum is an indication of life-threatening pulmonary edema.

B) b. Shortness of breathFeedback: INCORRECT Incorrect: Shortness of breath is not the most emergent sign or symptom of those listed.

C) c. Increased abdominal girthFeedback: INCORRECT Incorrect: Increased abdominal girth is not an emergent sign or symptom for this client.

D) d. Inability to sleep in the recumbent position, requiring pillowsFeedback: INCORRECT Incorrect: Inability to sleep in the recumbent position is not an emergent sign or symptom for this client.



6. Harvey is a 76-year-old man being followed up by his nurse practitioner for congestive heart failure (CHF). Which assessment finding does the nurse find in this client that is not a cause for concern?

A) a. Auscultation of cracklesFeedback: INCORRECT Incorrect: Lung crackles are not normal in this client and should be assessed further.

B) b. Pedal edemaFeedback: INCORRECT Incorrect: Pedal edema is not normal in this client and should be assessed further.

C) c. Weight loss of 6 pounds since the last visitFeedback: CORRECT Correct: Weight loss in this client indicates effective diuretic drug therapy.

D) d. Eating seven large cups of ice chips dailyFeedback: INCORRECT Incorrect: This could be a sign of anemia or noncompliance with fluid restrictions.



7. The nurse is providing discharge teaching to the client recovering from heart failure. Which statement by the client indicates that the nurse's instruction was effective?

A) a. ''If I am thirsty, that is my body telling me to drink more fluids.''Feedback: INCORRECT Incorrect: Fluid restriction must be closely monitored. The client should not wait until he or she is thirsty before ingesting fluids.

B) b. ''If I get swollen ankles, I should take another 'water pill' (diuretic).''Feedback: INCORRECT Incorrect: Medication should be taken on a regular basis as ordered, not according to the presence or absence of symptoms.

C) c. ''Swollen ankles are the best indicator of fluid retention.''Feedback: INCORRECT Incorrect: The presence of swollen ankles is not an accurate indicator of fluid retention.

D) d. ''Weight gain is the best indicator of fluid retention.''Feedback: CORRECT Correct: Weight should be measured and documented the same time every day to assess for fluid retention.



8. The client who has been admitted for the third time this year for cardiac failure says, ''This isn't worth it anymore. I just want it all to end.'' What is the nurse's best response?

A) a. Calls the family to lift the client's spiritsFeedback: INCORRECT Incorrect: Calling the family to help distract the client does not address the core issue at hand.

B) b. Considers further assessment for depressionFeedback: CORRECT Correct: This client is at risk for depression because of the diagnosis of heart failure and further assessment should be done.

C) c. Sedates the clientFeedback: INCORRECT Incorrect: Sedation is inappropriate in this situation.

D) d. Tells the client that things will get betterFeedback: INCORRECT Incorrect: Telling the client that things will get better gives the client false hope.



9.

The disease management nurse is teaching the client ways to reduce preload. The first intervention talked about is maintaining fluid and sodium restrictions. Which occurrence reported by the client indicates that teaching and implementation was successful?

A) a. Pants that have become loose in the waistFeedback: CORRECT Correct: Weight is the best indicator of fluid retention or loss. This client's weight loss indicates successful compliance with fluid and sodium restrictions.

B) b. Removal of wedding ring because of tightnessFeedback: INCORRECT Incorrect: Swollen fingers indicate fluid retention.

C) c. Urinating frequently at nightFeedback: INCORRECT Incorrect: Urinating frequently at night is not indicative of the client's diet restrictions.

D) d. Pants that have become tight in the waistFeedback: INCORRECT Incorrect: Weight gain does not indicate decreased preload but can indicate fluid retention or a metabolic imbalance.



10. The client is admitted to the hospital with shortness of breath and intermittent chest pain. A cardiac catheterization shows inadequate relaxation of the left ventricle during diastole, and the ejection fraction is 48%. Which type of heart failure might this client be experiencing?

A) a. Diastolic heart failureFeedback: CORRECT Correct: Diastolic heart failure occurs when the left ventricle is unable to relax adequately during diastole. Inadequate relaxation or ''stiffening'' prevents the ventricle from filling with sufficient blood to ensure an adequate cardiac output. Although the ejection fraction is higher than 40%, the ventricle becomes less compliant over time because more pressure is needed to move the same amount of volume as compared with a healthy heart.

B) b. High-output failureFeedback: INCORRECT Incorrect: High-output failure can occur when cardiac output remains normal or above normal, unlike left- and right-sided heart failure, which are typically low-output states.

C) c. Systolic ventricular dysfunctionFeedback: INCORRECT Incorrect: Systolic ventricular dysfunction results when the heart is unable to contract forcefully enough during systole to eject adequate amounts of blood into the circulation. Preload increases with decreased contractility, and afterload increases as a result of increased peripheral resistance.

D) d. Ventricular failureFeedback: INCORRECT Incorrect: Decreased tissue perfusion from poor cardiac output and pulmonary congestion from increased pressure in the pulmonary vessels indicate left ventricular failure (LVF).



11. Which nursing diagnoses may be considered for the client with heart failure? (Select all that apply.)

A) a. Excess Fluid Volume related to compromised regulatory mechanismFeedback: CORRECT Correct: This diagnosis may be attributed to the client with heart failure.

B) b. Impaired Physical Mobility related to limited cardiovascular enduranceFeedback: CORRECT Correct: This diagnosis may be attributed to the client with heart failure.

C) c. Impaired Gas Exchange related to ventilation perfusion imbalanceFeedback: CORRECT Correct: This diagnosis may be attributed to the client with heart failure.

D) d. Potential for Pulmonary EdemaFeedback: CORRECT Correct: This diagnosis may be attributed to the client with heart failure.

E) e. Risk for Ineffective Tissue Perfusion, renal, related to hypervolemiaFeedback: INCORRECT Incorrect: This diagnosis may be attributed to the client with hypovolemia.


Correct Answer(s): A, B, C, D

12. The client is prescribed digoxin after having open heart surgery and postoperative atrial fibrillation. Which statement by the client demonstrates the need for further teaching about digoxin therapy?

A) a. ''I must keep all my laboratory appointments.''Feedback: INCORRECT Incorrect: Clients on digoxin therapy should be regularly tested for drug toxicity.

B) b. ''I should not take digoxin at the same time as antacids or laxatives.''Feedback: INCORRECT Incorrect: Digoxin should not be combined with antacids or laxatives because they interfere with absorption.

C) c. ''I should notify my doctor if my pulse is less than 60 or more than 100 beats per minute.''Feedback: INCORRECT Incorrect: A pulse rate of less than 60 or more than 100 beats/min indicates abnormality and the client should notify the health care provider immediately.

D) d. ''If I forget to take digoxin one day, I should double up on the dose the next day.''Feedback: CORRECT Correct: A forgotten dose may be delayed a few hours. However, if it is remembered just on the next day, only the usual daily dose should be taken.



13. What are important considerations when administering a human B-type natriuretic peptide (hBNP) such as nesiritide (Natrecor) for acute cardiac failure? (Select all that apply.)

A) a. Carefully monitor blood pressure.Feedback: CORRECT Correct: Blood pressure should be monitored in clients taking hBNPs.

B) b. Carefully monitor respiratory rate.Feedback: INCORRECT Incorrect: It is not necessary to monitor the respiratory rate of clients taking hBNPs.

C) c. Give every 8 hours.Feedback: INCORRECT Incorrect: hBNPs are given as 1-hour boluses followed by a 48-hour infusion.

D) d. Keep the client NPO (nothing by mouth).Feedback: INCORRECT Incorrect: It is not necessary for clients taking hBNPs to be on NPO status.

E) e. Use a separate infusion line.Feedback: CORRECT Correct: hBNPs are not compatible with heparin and most other parenteral medications. Thus, a separate infusion line must be used.


Correct Answer(s): A, E

14. Although the client with cardiac failure is asymptomatic, the nurse suspects noncompliance to the prescribed home therapy. Which laboratory test confirms the nurse's suspicions?

A) a. B-type natriuretic peptide (BNP)Feedback: INCORRECT Incorrect: A BNP test is a cardiac failure diagnostic tool, but is not the first indicator of decreased cardiac compliance.

B) b. ElectrolytesFeedback: INCORRECT Incorrect: Electrolytes are not an early indicator of decreased cardiac compliance.

C) c. Hemoglobin and hematocritFeedback: INCORRECT Incorrect: Hemoglobin and hematocrit are not an early indicators of decreased cardiac compliance.

D) d. Digoxin level of 0.2 ng/dLFeedback: CORRECT Correct: A therapeutic digoxin level is 0.5 to 0.8 ng/dL. A level of 0.2 ng/dL indicates the client has not been taking his or her digoxin dose correctly.



15. The nurse is caring for the client with congestive heart failure (CHF) in the coronary care unit (CCU). The client is now exhibiting signs of air hunger and anxiety. Which nursing intervention does the nurse perform first for this client?

A) a. Determines the client's physical limitationsFeedback: INCORRECT Incorrect: Determining the client's physical limitations is not a priority in this situation.

B) b. Encourages alternate rest and activity periodsFeedback: INCORRECT Incorrect: Encouraging alternate rest and activity periods is not the immediate priority for this client.

C) c. Monitors and documents heart rate, rhythm, and pulsesFeedback: INCORRECT Incorrect: Monitoring heart rate, rhythm, and pulses is important, but not the priority for this client.

D) d. Positions the client to alleviate dyspneaFeedback: CORRECT Correct: Positioning the client to alleviate dyspnea will help ease air hunger and anxiety.



16. The client is exhibiting signs of pulmonary edema as a result of congestive heart failure (CHF). Which nursing intervention demonstrates best practice in the care of this client?

A) a. Auscultating the lung sounds anteriorly.Feedback: INCORRECT Incorrect: Auscultating the lung sounds is not the priority for this client.

B) b. Placing the client in a semi-Fowler's position if blood pressure is adequateFeedback: INCORRECT Incorrect: Having the client dangle the feet with the head of the bed up is a better position to decrease venous return and pulmonary congestion.

C) c. Administering high-flow oxygen at 5-6 liters via simple face mask to maintain SpO2 at >90%Feedback: CORRECT Correct: Increasing tissue perfusion by oxygenation is the priority nursing action for this client.

D) d. Providing an oral diureticFeedback: INCORRECT Incorrect: Intravenous diuretics, not oral diuretics, are indicated for this client.



17. The home care nurse is caring for the client recently discharged from the hospital with a congestive heart failure (CHF) exacerbation. Which statement by the client indicates the need for further teaching about the nurse's plan of care?

A) a. ''I may have a cough.''Feedback: CORRECT Correct: A cough is indicative of CHF.

B) b. ''I will measure how much I eat and drink.''Feedback: INCORRECT Incorrect: Measuring food and fluid intake is important for effectively managing the client with CHF.

C) c. ''My nurse will ask how many pillows I sleep on at night.''Feedback: INCORRECT Incorrect: Positioning is an important factor for effectively managing the client with CHF.

D) d. ''I will be assessed for overnight weight gain.''Feedback: INCORRECT Incorrect: Weight assessment is an important factor for effectively managing the client with CHF.



18.

Which statement is true of valvular heart disease or disorders?

A) a. Clients with aortic insufficiency may present with symptoms of dyspnea on exertion, atrial fibrillation, and hemoptysis.Feedback: INCORRECT Incorrect: Principal concerns for clients with aortic insufficiency are exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.

B) b. Clients with mitral valve prolapse (MVP) may present with symptoms of atypical pain, palpitations, and atrial tachycardia.Feedback: CORRECT Correct: Most clients with MVP are asymptomatic. However, some may report chest pain, palpitations, or exercise intolerance. Atypical chest pain is usually described as a sharp pain localized to the left side of the chest.

C) c. In clients with aortic regurgitation, the aortic orifice narrows and obstructs left ventricular outflow during systole.Feedback: INCORRECT Incorrect: In aortic regurgitation, the aortic valve leaflets do not close properly during diastole, and the valve ring may be dilated, loose, or deformed. This allows regurgitation of blood from the aorta back into the left ventricle during diastole.

D) d. In mitral stenosis, the valve leaflets fuse and become stiff, and the chordae tendineae lengthen and become weak.Feedback: INCORRECT Incorrect: The chordae tendineae contract and shorten in mitral stenosis.



19. Which statement is true about the surgical management of valvular disease?

A) a. Although the timing of surgery is important in the recovery process, it is not crucial.Feedback: INCORRECT Incorrect: Timing of the surgery is crucial.

B) b. Repair or replacement of the valve is usually performed after symptoms of left ventricular failure have developed, but before irreversible dysfunction has occurred.Feedback: CORRECT Correct: Surgery is typically performed after symptoms of the disorder have developed.

C) c. Surgery can still be done in the presence of irreversible dysfunction.Feedback: INCORRECT Incorrect: Surgery does not return the valve to normal, but it does improve cardiac output.

D) d. Surgical therapy is one of the definitive treatments for mitral stenosis.Feedback: INCORRECT Incorrect: Surgical therapy is not a definitive treatment of mitral stenosis.



20. The nurse is educating the client who has undergone a mitral valve replacement for severe regurgitation. Which statement by the client indicates the need for further teaching?

A) a. ''I don't need to take any more medications.''Feedback: CORRECT Correct: Clients who have had mitral valve replacement usually have a complicated drug regimen to follow.

B) b. ''I should call my doctor if I get a fever, shortness of breath, or heart palpitations.''Feedback: INCORRECT Incorrect: Fever, shortness of breath, or heart palpitations can indicate infection or a valve problem.

C) c. ''I may hear my heart 'click'.''Feedback: INCORRECT Incorrect: A ''clicking'' sound may be heard in clients who have had mitral valve replacement surgery.

D) d. ''I should remind my dentist of my valve problem.''Feedback: INCORRECT Incorrect: Clients who have had mitral valve replacement surgery must inform other health care providers because of the increased risk of infection.



21.

The nurse is assessing the client with a cardiac infection. Which symptoms support the diagnosis of infective endocarditis instead of pericarditis or rheumatic carditis?

A) a. Friction rub auscultated at the left lower sternal borderFeedback: INCORRECT Incorrect: Friction rub in the left lower sternal border is a sign of chronic constrictive pericarditis.

B) b. Pain aggravated by breathing, coughing, and swallowingFeedback: INCORRECT Incorrect: Pain aggravated by breathing, coughing, and swallowing is indicative of signs and symptoms of chronic constrictive pericarditis.

C) c. Splinter hemorrhagesFeedback: CORRECT Correct: Splinter hemorrhages are indicative of infective endocarditis.

D) d. Thickening of the endocardiumFeedback: INCORRECT Incorrect: Thickening of the endocardium is indicative of rheumatic carditis.



22. The client had heart transplantation surgery 2 days ago and is experiencing extreme orthostatic hypotension. What does the nurse do?

A) a. Calls the surgeonFeedback: INCORRECT Incorrect: Calling the surgeon is not necessary at this point.

B) b. Cautions the client to change positions slowlyFeedback: CORRECT Correct: Orthostatic hypotension is an expected side effect of the surgery because of heart denervation.

C) c. Gives pain medicationFeedback: INCORRECT Incorrect: Pain medication is not indicated for the client in this situation.

D) d. Increases intravenous fluidsFeedback: INCORRECT Incorrect: The client's symptoms do not indicate an increase in IV fluids.



23. The client, a college athlete who has collapsed during soccer practice, has been diagnosed with hypertrophic cardiomyopathy. The client says, ''This can't be. I am in great shape. I eat right and exercise.'' What is the nurse's best response?

A) a. ''How does this make you feel?''Feedback: INCORRECT Incorrect: Exploring the client's feelings is important, but this response does not address the client's question.

B) b. ''It can be caused by taking performance-enhancing drugs.''Feedback: INCORRECT Incorrect: Hypertrophic cardiomyopathy is not caused by performance-enhancing drugs.

C) c. ''It can be a genetic trait.''Feedback: CORRECT Correct: Hypertrophic cardiomyopathy is often transmitted as a single-gene autosomal dominant trait.

D) d. ''Just imagine how bad it would be if you weren't in good shape.''Feedback: INCORRECT Incorrect: This response is not at all therapeutic, and does not address the client's question.



quiz 35, 36, 37

Documents

Transcript of quiz 35, 36, 37