What is the normal pattern of blood flow through the heart?
vena cava, R atrium, tricuspid valve, R ventricle, pulmonic valve, pulmonary artery, lung, pulmonary vein, L atrium, mitral valve, L ventricle, aortic valve, aorta, systemic circulation
A client assessment reveals muffled heart tones, clear lungs, and an increase of 13 mm Hg systolic on inspiration of hemodynamic monitoring. After notifying physician, what are the expected interventions? SELECT ALL THAT APPLY.
Prepare for pericardiocentesis
Provide oxygen
Administer fluids
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A client is seen for a cardiovascular evaluation. He describes having “heartburn” and numbness in his left shoulder and neck. The client is scheduled for cardiac catheterization and coronary angiography. Which priority intervention does the nurse plan for post-procedural care?
Check peripheral pulses every 15 minutes during the first hour post-procedure.
A client was admitted to rule out myocardial infarction (MI). Which of the following blood tests will be monitored within the first day to most reliably help determine if a MI has occurred?
Troponin I
A client is scheduled to have an echocardiogram. He has a history of a murmur and new palpitations. He is anxious and asks the nurse, “What in the world is an echocardiogram going to tell the doctors about my heart? Why are they wasting my money this way?” Which of the following responses may aid his understanding of this procedure?
“The echocardiogram is a low-risk diagnostic test that can provide the doctor with a picture of your heart and its internal structures like your heart valves.”
A client is scheduled for a cardiac catheterization. What must be included pre-operatively to ensure safety of the client?
Alert the cardiac cath lab of patient allergy to shellfish
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Which of the following diagnostic test results will cause the nurse to carefully assess the client’s cardiac function?
Serum potassium of 2.9 meq/dL
The force needed for the heart to open the aortic and pulmonic valves is known as:
Afterload
How would the nurse interpret the risk of atherosclerotic disease in a client’s lipid profile results when the LDL (low density lipoprotein) is elevated?
No change in risk, this value must be interpreted with other history factors such as smoking
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The nurse is setting up an arterial line, which location is correct positioning of the transducer.
(phlebostatic axis) Answer: C
The PCT is assisting a client to the commode when suddenly the client falls. After assessing the client, the RN in charge of the care suspects vaso-vagal response. This response can be explained by the effects of:
the parasympathetic nervous system
A client has infective endocarditis secondary to IV drug use. What complication of infective endocarditis the nurses should monitor for?
Pulses paradoxus
The nurse is attempting to identify the timing of a murmur detected in a client. What additional assessment is necessary in order to determine the timing of the murmur?
Identification of the S1 and S2
A client is admitted with fever, chills, and generalized aching. The physician suspects infective endocarditis and writes the following orders: blood for culture and sensitivity, ASA (aspirin) for temperature above 102 F (38.9C), IV antibiotics, and CBC (or hemoprofile) , Comprehensive serum chemistry, and EKG. Which of the following must be completed first?
Blood cultures
The nurse is assessing their arterial line and identifies the following two comparisons from different times:
What is the nurses next action?
Re-zero the arterial line
The incidence of rheumatic heart disease has been reduced through prevention. Nurses who want to continue to prevent this disease need to promote which of the following activities?
Teaching people to seek medical attention and treatment with antibiotics when streptococcal infections occur
A client has a mitral valve replacement using a mechanical valve. Which information does the nurse include in the postoperative teaching plan?
The need for anticoagulation therapy as long as the valve remains in the body
Which of the following describes problem of mitral valve regurgitation?
Some blood flows into the left atrium during ventricular diastole.
While auscultating S1 and S2, the nurse notes a friction rub. The client is also complaining of left chest pain. What might the nurse suspect?
acute pericarditis
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A client with valvular dysfunction needs to reduce afterload to improve cardiac output. What medications will assist in achieving that? SELECT ALL THAT APPLY
-Calcium Channel Blockers
-Angiotensin-Converting Enzyme (ACE) Inhibitors
-Lisinopril
The nurse has selected the diagnosis of Risk of Infection r/t past history of rheumatic heart disease with mitral valve damage. Which of the following goals is most appropriate?
Client will state rationale for taking antibiotics before procedures such as dental work
The nurse is assessing a client who’s pulmonary artery wedge pressure (PAWP) is 16 mm Hg (normal 4-12 mm Hg), and they are weak and feel dizzy. What might the nurse suspect is causing these symptoms?
Decreased cardiac output secondary to mitral stenosis
The RN performing an admission assessment notes pulsing in the client abdomen. Which of the following client history would support the RN’s decision to immediately notify the physician?
Atherosclerosis
Priority assessments for the client who just had a stent placed for Abdominal Aortic Aneurysm should include: SELECT ALL THAT APPLY
Evaluate capillary refill of patient toes
Assess dorsalis pedis pulse.
Assess urine output every hour.
The time is 1300. Consider the following data and select an appropriate nursing intervention.
| History | Assessment | Labs |
| 59 y.o. male | Mediastinal Chest Tubes to -20cm of suction | 1000:
PT = 14 seconds PTT = 31 seconds |
| Coronary Artery Bypass x 3 grafts 5 hours ago | Chest tube drainage
1300 200 mL, Dark red 1200 200 mL, Dark red 1100 250 mL, Dark red |
1000:
Hemoglobin = 11.6 gm |
| 103/61, 109 (regular),
18 Respiratory rate, SpO2 = 94 37C (98.6F) |
Consider the following data and select the priority nursing intervention.
| History | Assessment | Physician Orders |
| Diagnosis: Thoracic Aortic dissecting aneurysm | 144/88, P 92, R 18, 36.4C (97.6F) | Bedrest with bathroom privileges |
| New admit | Complains of hunger, bored with inactivity, and wants to talk to physician | Clear liquid diet
1L NS at 30 mL/hour |
| Vital signs Q 1 hour
Cardiac monitor |
||
| Morphine 4-6 mg IVP Q 1 hour pain
Labetalol 20 mg IVP Q 4 hours prn SBP> 120 mm Hg |
Administer Labetalol.
systolic blood pressure of 152 mm Hg
The best source of a graft vessel for the CABG (coronary artery bypass graft) is the:
Choose the best explanation for the following Dr. orders in the post CABG client:
Draw serum potassium levels (K) q 4 hours.
For serum K results of :
3 – 3.5 meq/L administer IVPB 40meq of KCL in 120mL of D5W over 2 hours
3.5 – 4 meq/L administer IVPB 20meq of KCL in 60mL of D5Wover 1 hour
4 – 4.5 meq/L administer IVPB 10meq of KCL in 30mL of D5W over 1hour
Low serum K can cause arrhythmia’s.
From the following, select the client who is most likely to require a heart transplant to treat their condition.
Progressive cardiomyopathy.
Select the nurse’s best response to the client who is trying to decide about being placed on the heart transplant waiting list after the they state: “I am so tired of being sick and seeing doctors and nurses and lab tech’s all the time! I just want this to be over. Nurse, do you think I should have a heart transplant?”
“Tell me what you do know about having a heart transplant?”
A Swan-Ganz catheter is being placed at the bedside by the physician. The nurse is aware that she must notify the physician of a major complication from this placement. What would the nurse notify the physician about?
Cardiac rhythm change to a ventricular arrhythmia
A client has a newly placed right intra-aortic balloon pump (IABP). The nurse wants to prevent arterial trauma from displacement of the balloon. Which action by the nurse is most appropriate to prevent this complication?
Position the client to prevent hip flexion of the right leg
To monitor for the complications of a right radial artery arterial line placement the nurse will: (Select the BEST response)
Check temperature and sensation of right hand.
The nurse obtained a pulmonary artery wedge pressure (PAWP) reading, after finished, the balloon is deflated, but it remained in a ‘wedged’ waveform, what should the nurse do?Notify physician immediately
An intra-aortic balloon pump (IABP) was initiated but unsuccessful in maintaining cardiac output for a client. A left ventricular assist device is their last effort. The client asks “What is this machine going to do for me?” The nurse’s best response is:
“It is going to help increase the blood flow through your heart.”
A client has had a mechanical mitral valve replacement and is on warfarin (Coumadin) p.o. 5mg every day. Individuals taking the anticoagulant warfarin must be counseled to avoid eating too much of which of the following foods?
Which of the following menu choices indicates that the client on a “heart healthy” diet is trying to follow the physician’s recommendations?
Which element of the diet should be restricted to decrease the ‘pre-load’ of the heart?
A client with excessive systemic vasodilation is given a vasopressor, what effect will it have on the heart?
A client is receiving a drug that decreases peripheral arterial resistance.
Which effect does the nurse anticipate this drug will have on the cardiac function?
A decrease in afterload.
The client has developed cardiac tamponade. What is the priority nursing diagnosis?Decreased cardiac output r/t decreased preload and contractility
Which class of medications does the drug metoprolol (Lopressor) belong to?
Beta blocker.
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Which of the following statements by the client would indicate that they understand the nurses teaching related to furosemide (Lasix) 20mg po q day?
Which of the following client care assignments would be most appropriate for the R.N. pulled to a busy cardiac inpatient unit from the medical-surgical intensive care unit?
Although we have 5 nurses for 18 clients, one of those nurses has been pulled from the pediatrics floor and we have 3 more admissions coming in. We could use someone to help with the IV restarts and medications.
The nurse is given their assignment, based upon bedside report, which is the nurse’s priority to assess first?
The nurse is assessing their ICU client. The mean arterial pressure (MAP) reads 57 mm Hg, HR 55, RR 9. What does this signify to the nurse?
A Post cardiac catheterization client, with stent placed to the left anterior descending (LAD), was just transferred to cardiac floor with sheath still in place.
The nurse has the following orders:
| Regular diet | Pulse checks with VS | Oxygen to keep SpO2 >95% |
| Bedrest | Sheath check with VS | Nitroglycerine 0.4 mg sublingual prn for CP |
| VS q15 for 1h, q30 for 2h, then q4h |
A
The client has had a myocardial infarction (MI), the nurse should expect the following interventions for management of care: SELECT ALL THAT APPLY
Oxygen
Beta-blockers
The nurse walks into their clients room which was admitted 3 days ago for myocardial (MI) infarction. The nurse observes them leaning forward, and the client describes increased chest pain with coughing. What does the nurse expect is occurring?
A client is admitted to rule out myocardial (MI) infarction. They are initially pale, diaphoretic, and have chest pain of 9 on a scale of 0-10. He has been pain free for 2 hours but is now having of chest pain. The nurse’s first response is:
A client is being evaluated to rule out mitral valve stenosis. Which assessment data is most significant?
The client complains of shortness of breath when walking.
The charge nurse is making shift assignments. Which client would be most appropriate for the new graduate nurse who just completed orientation to the unit?
– Have (minimum) an annual checkup with a physician, including blood work
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