Cardiac Nursing
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- When someone has mitral stenosis, where in the heart is it going to affect?
- Left atrium."
- A patient develops a headache when on Isordil, what is your best action?
- Document as normal."
- You are listening to the base of the lungs sounds that are dull, what is your best action?
- Call the doctor."
- What diet would you recommend with low cholesterol?
- Skim milk, cereal, apples."
- A patient has Burgers disease, what would you notice?
- Rubor and diminished pulses."
- A patient has already take 3 nitros, what would your action be?
- Call the doctor."
- Someone has heart failure, what would be a sign/symptom:
- Going half way up the stairs and being short of breath"
- You discover a murmur, what are you going to tell your patient it is?
- That is a flow of blood and it can be normal or abnormal."
- A patient has an echocardiogram, what are you looking at?
- Structures and valves of the heart."
- A patient is taking aspirin and nitro, what do these meds do?
- Decrease platelet aggregation."
- A patient needs to weigh themselves daily, why are they doing this?
- Weight is the best indicator that you are gaining or loosing fluid.."
- Someone who has peripheral arterial disease and they need to promote vasodilation, what are you going to teach them?
- To abstain from smoking."
- A person has peripheral arterial disease, what are you going to notice?
- Rubor in a dependent position."
- Someone with an abdominal aortic aneurism, they have pain that radiates from the back to the groin, what does this indicate?
- That the tumor is expanding."
- What are you going to teach a patient who is on an ace inhibitor?
- Call when they want to ambulate.
- What is a reaction to a beta blocker?
- Bronchospasm
- Someone who has a valve replacement and has a defect, how are you going to know if they have something wrong?
- If the patient went to the dentist."
- What is a sign/symptom of aortic stenosis?
- Narrow pulse pressure.
- Who is most likely to have hypertension?
- 45 yr old black male with diabetes.
- You are looking at an ultrasound and the heart has increased in size and shifted to the left, what does this indicate?
- Hypertrophy."
- A side effect of Lasix is?
- Hypokalemia.
- What do you want to teach a patient who is on an ace inhibitor?
- Don’t take salt substitutes.
- What do you want to teach a patient who is on digoxin?
- Don’t take antacids.
- A patient who is on digoxin and is hypokalemic, what do you want to monitor?
- The PR interval and heart rate."
- Someone who is on lovenox, what are you going to tell the patient when to call the doctor?
- If they have black tarry stools."
- What do you want to teach a patient who has venous problems?
- Put stockings on before they get out of bed.
- A person is complaining of chest pain but does not believe they are having it. What is this person going to do?
- Wait 2 hours before calling the doctor or going to the hospital.
- A person is mowing the lawn and suddenly has chest pain, they stop and rest and the pain goes away. What does this indicate?
- Stable angina."
- What do you want to teach a patient who is using a nitro patch?
- Rotate the sites.
- What does a person need to have every year if they have hypertension?
- Retinal exam.
- A patient has atherosclerosis, how is it developing?
- Platelet and fat building in the arteries."
- A person has a normal myoglobin, what does this indicate?
- No MI present."
- A person is taking Zocor, what is the action of this drug?
- To lower LDL and triglycerides."
- A person has a thalium test done and the entire heart has filled with the dye, what does this indicate?
- A normal test."
- What do you want to teach someone about diet?
- <10% saturated fats.
- A person has pericarditis, as a nurse what are you going to assess for?
- Friction rub."
- A person has HTN, what are you going to teach them about diet?
- Avoid eating canned foods."
- A person who has heart failure, their Baroreceptors kick in, what are you going to see?
- An increase in heart rate."
- A person who is overworking the heart, what is a sign?
- A decrease in BP and heart rate from 86 – 110."
- A person is on heparin, where should the levels be?
- 2 times baseline"
- A person develops pain while walking, which disease is this? "
- Peripheral arterial disease.
- A person who has CHF, what will teaching be?
- To weigh themselves everyday with the same amount of clothing."
- A person develops increased preload, which mechanism is causing this?
- The renin-angiotensin system."
- A person is put on anticoagulation after a valve replacement, why?
- To prevent hemolysis of valves and stitches."
- A person is post Triple A, what are you going to monitor?
- Abdominal girth and heart rate."
- A person is on Lasix, what are you going to teach them?
- To increase their potassium in their diet."
- A person has CHF, what are you going to see?
- Increase LVED and decreased cardiac output."
- A person has a 38% ejection fraction, what are you going to assess?
- Tissue perfusion."
- A person is on nitro, what are you as the nurse going to do?
- Wait 12 hours in between each dose because of effectiveness."
- Which nursing diagnosis should be considered priority for a client with heart failure?
- Impaired gas exchange.
- A 76-yr-old client has been prescribed Tamporil, an ace inhibitor, what NI is most important when giving the first dose?
- Instruct the pt. to ask for assistance when rising from bed. First dose can make you hypotensive."
- What is the ejection fraction for a 60-yr-old client whose left ventricle and diastolic volume is 124 ml and LV and stroke volume is 55?
- 44%????
- You listen to the posterior lungs of a client with heart failure, you notice an increase in dullness at the bases, what is your best action?
- Notify physician (put patient in high fowlers to take fluid as low as you can get it."
- A client with heart failure develops an increase in preload, what pathophysiological process is responsible for these changes?
- Activation of the renin angiotensin aldosterone system."
- Pt. hospitalized with chest pain, ordered transdermal nitroglycerin, the nurse included in her teaching plan that the reasons for the nitro is to?
- Increase the O2 to the heart decreases preload, decreases myocardial fill, decreases the contractility needed, and decreases the O2 demand."
- First dose of digoxin is to?
- Establish a therapeutic level.
- The nurse evaluated the effectiveness of digoxin, an expected outcome is?
- Increased urine output."
- The nurse assesses the patient pulse before administering Digoxin. If the pulse is 68 at 8a.m. and 62 at 9 a.m., what should the nurse do?
- Administer the drug as ordered."
- Pt. developed pericarditis after a viral infection. Pericarditis results in fluid accumulation and pus in the pericardial sac. As the fluid increases in the pericardial sac, the cardiac output will decrease because?
- Decreased ventricular filling."
- What do you do for Reynaud’s? .
- Avoid cold weather
- A patient with peripheral vascular disease, for years she has taken an evening walk, but lately even short walks result in leg pain and muscle cramps. After she rests, the pain is relieved, the most likely cause is?
- Intermittent claudication d/t inadequate oxygen."
- A client brought to ER with MI why is the damage to the myocardium problematic for this patient?
- There is now decreased contractility.
- The client brought initially to ER with the MI is found to be hypotensive what effect from the baroreceptor stimulation on this client’s heart rate would be expected?
- The heart rate will increase.
- A client with a history of congestive heart failure has excessive filling of the ventricles as a result what physiologic response would you expect to see in this client?
- Excessive preload and decreased cardiac output.
- A client undergoing stress test at what point do you end the test?
- When the client is observed to be cold and clammy.
- What techniques should the nurse use to best auscultate the second heart sound (aortic)?
- Second intercostals space.
- A client who has experienced an MI developed LV heart failure, which sign of poor organ perfusion should you remain alert for? "
- Urine output less than 30ml/hour
- A client is receiving heparin therapy for DVT which of the following APTT indicates to you that the anticoagulation is adequate?
- 2 times PTT doubled.
- The healthcare provider has prescribed the client with DVT to be started on oral warfarin Coumadin while still receiving IV heparin, what is your best action?
- Administer both and watch the PT and PTT."
- What health teaching should be included in the continuing plan for a pt. with chronic venous stasis ulcers (occurs d/t swelling and decreased venous return)?
- Apply anti-embolism stocking before getting out of bed in the morning to facilitate venous return.
- What monitoring technique should be AVOIDED by the nurse caring for a client with an abdominal aneurysm?
- Palpation of the abdominal area – it can rupture
- The client is to begin taking hydrochlorothiazide to control HTN, what instruction should be given to this client before beginning therapy?
- Food should be high in potassium."
- The client is receiving _____, a beta blocker as part of the treatment of HTN, what side effect should you be most alert for?
- Respiratory problems."
- Client admitted with exacerbation of heart failure, which of the following nursing interventions would you perform first?
- Assess respiratory and oxygen status."
- Which of the following clinical manifestation of the client with CHF undergoing progressive increase in activity?
- Pulse above 20 beats change.
- A client with CHF being treated with digoxin develops hypokalemia, what action should you prepare to take?
- (not a K bolus first – dangerous)"