Different Symptoms Of Heart Disease

1. A 66 year-old client is admitted for mitral valve replacement surgery.The client has ahistory of mitral valve regurgitation and mitral stenosis since her teenageyears. During theadmission assessment, the nurse should ask the client if as a child shehad

Rheumatic fever

Hay fever

Measles

Encephalitis

Clients that present with mitral stenosis often have a history
of rheumatic fever or bacterial endocarditis.

Explanation

Clients that present with mitral stenosis often have a history
of rheumatic fever or bacterial endocarditis.

2. An early finding in the EKG of a client with an infarcted mycardiumwould be:

Elevated ST segments

Disappearance of Q waves

Absence of P wave

Flattened T waves

This is a typical early finding after a myocardial infarct because of the
altered contractility of the heart. The other choices are not typical of MI.

Explanation

This is a typical early finding after a myocardial infarct because of the
altered contractility of the heart. The other choices are not typical of MI.

3. A 66 year-old client is admitted for mitral valve replacement surgery.The client has ahistory of mitral valve regurgitation and mitral stenosis since her teenageyears. During theadmission assessment, the nurse should ask the client if as a child shehad

Rheumatic fever

Measles

Hay fever

Encephalitis

Clients that present with mitral stenosis often have a history
of rheumatic fever or bacterial endocarditis

Explanation

Clients that present with mitral stenosis often have a history
of rheumatic fever or bacterial endocarditis

4. Valsalva maneuver can result in bradycardia. Which of the followingactivities will not stimulate Valsalva's maneuver?

Use of stool softeners

Enema administration

Gagging while toothbrushing.

Lifting heavy objects

Straining or bearing down activities can cause vagal stimulation
that leads to bradycardia. Use of stool softeners promote easy bowel
evacuation that prevents straining or the valsalva maneuver.

Explanation

Straining or bearing down activities can cause vagal stimulation
that leads to bradycardia. Use of stool softeners promote easy bowel
evacuation that prevents straining or the valsalva maneuver.

5. After the acute phase of congestive heart failure, the nurse shouldexpect the dietary management of the client to include the restriction of:

Sodium

Potassium

Calcium

Magnesium

Restriction of sodium reduces the amount of water retention that reduces
the cardiac workload

Explanation

Restriction of sodium reduces the amount of water retention that reduces
the cardiac workload

6. Which of the ff. statements by the client to the nurse indicates arisk factor for CAD?

“I smoke 1 1/2 packs of cigarettes per day.”

“My cholesterol is 180.”

“My father died of Myasthenia Gravis.”

“I exercise every other day.”

“I smoke 1 1/2 packs of cigarettes per day.” Smoking has
been considered as one of the major modifiable risk factors for coronary
artery disease. Exercise and maintaining normal serum cholesterol levels
help in its prevention.

Explanation

“I smoke 1 1/2 packs of cigarettes per day.” Smoking has
been considered as one of the major modifiable risk factors for coronary
artery disease. Exercise and maintaining normal serum cholesterol levels
help in its prevention.

7. Which of the following should the nurse teach the client about thesigns of digitalis toxicity?

Visual disturbances such as seeing yellow spots

Skin rash over the chest and back

Elevated blood pressure

Increased appetite

Seeing yellow spots and colored vision are common symptoms of
digitalis toxicity

Explanation

Seeing yellow spots and colored vision are common symptoms of
digitalis toxicity

8. A client has been diagnosed with hypertension. The nurse prioritynursing diagnosis would be

Ineffective health maintenance

Impaired Skin Integrity

Pain

Deficient Fluid Volume

Managing hypertension is the priority for the client with hypertension. Clients with hypertension frequently do not experience pain, deficient volume or impaired skin integrity. It is the asymptomatic nature of hypertension that makes it so difficult to treat.

Explanation

Managing hypertension is the priority for the client with hypertension. Clients with hypertension frequently do not experience pain, deficient volume or impaired skin integrity. It is the asymptomatic nature of hypertension that makes it so difficult to treat.

9. Myra is ordered laboratory tests after she is admitted to the hospitalfor angina. The isoenzyme test that is the most reliable early indicatorof myocardial insult is

CK-MB

SGPT

LDH

AST

The cardiac marker, Creatinine phosphokinase (CPK) isoenzyme levels, especially the MB sub-unit which is cardio-specific, begin to rise in 3-6 hours, peak in 12-18 hours and are elevated 48 hours after the occurrence of the infarct. They are therefore most reliable in assisting
with early diagnosis. The cardiac markers elevate as a result of
myocardial tissue damage.

Explanation

The cardiac marker, Creatinine phosphokinase (CPK) isoenzyme levels, especially the MB sub-unit which is cardio-specific, begin to rise in 3-6 hours, peak in 12-18 hours and are elevated 48 hours after the occurrence of the infarct. They are therefore most reliable in assisting
with early diagnosis. The cardiac markers elevate as a result of
myocardial tissue damage.

10. An 18 month old with Tetralogy of Fallot has a "tet" spell afterhaving an invasive procedure. To improve the child's cardiac statuswhich of the following interventions should the nurse do initially:

Place the child in a knee chest position

Begin chest compressions

Administer oxygen

Position with HOB elevated

A "tet" spell is when the child is having difficulty meeting
oxygen demands. The knee chest position reduces venous blood return from
the lower extremities and increases vascular resistance to divert blood
flow to the pulmonary artery.

Explanation

A "tet" spell is when the child is having difficulty meeting
oxygen demands. The knee chest position reduces venous blood return from
the lower extremities and increases vascular resistance to divert blood
flow to the pulmonary artery.

11. Upon admission to an intensive care unit, a client diagnosed with anacute myocardialinfarction is ordered oxygen. The nurse knows that the major reason thatoxygen

Increase oxygen level in the myocardium

Relieve dyspnea

Saturate the red blood cells

Decrease cyanosis

Anoxia of the myocardium occurs in myocardial infarction. Oxygen administration will help relieve dyspnea and cyanosis associated with the condition but the major purpose is to increase the oxygen concentration in the damaged myocardial tissue.

Explanation

Anoxia of the myocardium occurs in myocardial infarction. Oxygen administration will help relieve dyspnea and cyanosis associated with the condition but the major purpose is to increase the oxygen concentration in the damaged myocardial tissue.

12. Nurse Trisha teaches a client with heart failure to take oralFurosemide in the morning. The reason for this is to help.

Prevents sleep disturbances during night

Excrete excessive fluids accumulated at night

Retard rapid drug absorption

Prevention of electrolyte imbalance

When diuretics are taken in the morning, client will void frequently during daytime and will not need to void frequently at night.

Explanation

When diuretics are taken in the morning, client will void frequently during daytime and will not need to void frequently at night.

13. A client with chronic heart failure has been placed on a dietrestricted to 2000mg. of sodium per day. The client demonstratesadequate knowledge if behaviors are evident such as not salting food andavoidance of which food?

Canned sardines

Whole milk

Plain nuts

Eggs

Canned foods are generally rich in sodium content as salt is
used as the main preservative.

Explanation

Canned foods are generally rich in sodium content as salt is
used as the main preservative.

14. You are providing care for a patient with Arterial Occlusive Disease,and writing a Nursing Care Plan. One of your interventions is to positionthe patient's legs below the level of the heart. From which of thefollowing Nursing Diagnoses is the above intervention MOST LIKELY derivedfrom:

Altered Tissue Perfusion

Potential for Altered Respiratory Function

High risk for pain

Potential for Activity Intolerance

Patients with Arterial Occlusive Disease have decreased
perfusion of tissues. By placing the patient in a dependent position,
blood flow to the lower extremities is enhanced, and, therefore, the
nursing diagnosis for this intervention would be Altered Tissue Perfusion

Explanation

Patients with Arterial Occlusive Disease have decreased
perfusion of tissues. By placing the patient in a dependent position,
blood flow to the lower extremities is enhanced, and, therefore, the
nursing diagnosis for this intervention would be Altered Tissue Perfusion

15. To prevent a valsalva maneuver in a client recovering from an acutemyocardial infarction, the nurse would

Administer stool softeners every day as ordered

Assist the client to use the bedside commode

Administer antidysrhythmics prn as ordered

Maintain the client on strict bed rest

Administering stool softeners every day will prevent straining
on defecation which causes the Valsalva maneuver. If constipation occurs
then laxatives would be necessary to prevent straining. If straining on
defecation produced the valsalva maneuver and rhythm disturbances
resulted then antidysrhythmics would be appropriate.

Explanation

Administering stool softeners every day will prevent straining
on defecation which causes the Valsalva maneuver. If constipation occurs
then laxatives would be necessary to prevent straining. If straining on
defecation produced the valsalva maneuver and rhythm disturbances
resulted then antidysrhythmics would be appropriate.

16. Dr. Marquez orders a continuous intravenous nitroglycerin infusion forthe client suffering from myocardial infarction. Which of the following isthe most essential nursing action?

Obtaining infusion pump for the medication

Obtaining serum potassium levels daily

Monitoring blood pressure every 4 hours

Monitoring urine output frequently

Administration of Intravenous Nitroglycerin infusion requires
pump for accurate control of medication

Explanation

Administration of Intravenous Nitroglycerin infusion requires
pump for accurate control of medication

17. Patrick who is hospitalized following a myocardial infarction asksthe nurse why he is taking morphine. The nurse explains that morphine:

Prevents shock and relieves pain

Decrease anxiety and restlessness

Helps prevent fibrillation of the heart

Dilates coronary blood vessels

Morphine is a central nervous system depressant used to relieve the pain associated with myocardial infarction, it also decreases apprehension and prevents cardiogenic shock.

Explanation

Morphine is a central nervous system depressant used to relieve the pain associated with myocardial infarction, it also decreases apprehension and prevents cardiogenic shock.

18. A client is scheduled for a percutaneous transluminal coronaryangioplasty (PTCA). The nurse knows that a PTCA is the

Procedure that compresses plaque against the wall of the diseased coronary artery to improve blood flow

Non-invasive radiographic examination of the heart

Placement of an automatic internal cardiac defibrillator

Surgical repair of a diseased coronary artery

PTCA (percutaneous transluminal coronary angioplasty) is
performed to improve coronary artery blood flow in a diseased artery. It
is performed during a cardiac catheterization. Aorta coronary bypass
Graft is the surgical procedure to repair a diseased coronary artery.

Explanation

PTCA (percutaneous transluminal coronary angioplasty) is
performed to improve coronary artery blood flow in a diseased artery. It
is performed during a cardiac catheterization. Aorta coronary bypass
Graft is the surgical procedure to repair a diseased coronary artery.

19. Mr. Ong is admitted to the hospital with a diagnosis of Left-sided CHF.In the assessment, the nurse should expect to find:

Dyspnea on exertion

Jugular vein distention

Extensive peripheral edema

Crushing chest pain

Pulmonary congestion and edema occur because of fluid extravasation from
the pulmonary capillary bed, resulting in difficult breathing. Left-sided heart failure creates a backward effect on the pulmonary system that leads to pulmonary congestion.

Explanation

Pulmonary congestion and edema occur because of fluid extravasation from
the pulmonary capillary bed, resulting in difficult breathing. Left-sided heart failure creates a backward effect on the pulmonary system that leads to pulmonary congestion.

20. During the second day of hospitalization of the client aftera Myocardial Infarction. Which of thefollowing is an expected outcome?

Able to perform self-care activities without pain

Can Participate in cardiac rehabilitation walking program

Severe chest pain

Can recognize the risk factors of Myocardial Infarction

By the second day of hospitalization after suffering
a Myocardial Infarction, Clients are able to perform care without chest pain

Explanation

By the second day of hospitalization after suffering
a Myocardial Infarction, Clients are able to perform care without chest pain

21. A client received digoxin (Lanoxin) therapy o treat the irregularbeating of his heart. The nurse knows that the therapy has beeneffective when the client with atrial fibrillation has an ECG tracingshowing:

A heart rate of 70 beats per minute

A heart rate of 105 beats per minute

Mobitz II heart block

A heart rate of 50 beats per minute

When the heart rate is above 60 beats per minute and below
10 beats per minute, digoxin therapy is deemed effective. However, if too
much digoxin was administered to the client, Mobitz II heart block may
be present.

Explanation

When the heart rate is above 60 beats per minute and below
10 beats per minute, digoxin therapy is deemed effective. However, if too
much digoxin was administered to the client, Mobitz II heart block may
be present.

22. Nurse Maureen would expect the client with mitral stenosis woulddemonstrate symptoms associated with congestion in the:

Pulmonary

Aorta

Superior vena cava

Right atrium

When mitral stenosis is present, the left atrium has difficulty
emptying its contents into the left ventricle because there is no valve to
prevent back ward flow into the pulmonary vein; the pulmonary
circulation is under pressure

Explanation

When mitral stenosis is present, the left atrium has difficulty
emptying its contents into the left ventricle because there is no valve to
prevent back ward flow into the pulmonary vein; the pulmonary
circulation is under pressure

23. A client who has been diagnosed of hypertension is being taught torestrict intake of sodium. The nurse would know that the teachings areeffective if the client states that…

I can eat shredded wheat cereal

I can eat spaghetti on rye bread

I can eat broiled scallops

I can eat celery sticks and carrots

Wheat cereal has low sodium content.

Explanation

Wheat cereal has low sodium content.

24. A woman in her third trimester complains of severe heartburn. Whatis appropriate teaching by the nurse to help the woman alleviate thesesymptoms?

Sleep with head propped on several pillows

Take sodium bicarbonate after each meal

Eat the evening meal just before retiring

Drink small amounts of liquids frequently

Heartburn is a burning sensation caused by regurgitation of
gastric contents that is best relieved by sleeping position, eating small
meals, and not eating before bedtime.

Explanation

Heartburn is a burning sensation caused by regurgitation of
gastric contents that is best relieved by sleeping position, eating small
meals, and not eating before bedtime.

25. Which of the following represents a significant risk immediately aftersurgery for repair of aortic aneurysm?

Potential alteration in renal perfusion

Potential electrolyte imbalance

Potential wound infection

Potential ineffective coping

There is a potential alteration in renal perfusion manifested by decreased urine output. The altered renal perfusion may be related to renal artery embolism, prolonged hypotension, or prolonged aortic cross clamping during the surgery.

Explanation

There is a potential alteration in renal perfusion manifested by decreased urine output. The altered renal perfusion may be related to renal artery embolism, prolonged hypotension, or prolonged aortic cross clamping during the surgery.

26. A nurse is caring for a 2 year-old child after corrective surgery forTetralogy of Fallot. The mother reports that the child has suddenly begunseizing. The nurse recognizes this problem is probably due to

A cerebral vascular accident

Postoperative meningitis

Medication reaction

Metabolic alkalosis

Polycythemia occurs as a physiological reaction to chronic
hypoxemia which commonly occurs in clients with Tetralogy of Fallot.
Polycythemia and the resultant increased viscosity of the blood increase
the risk of thromboembolic events. Cerebrovascular accidents may occur.
Signs and symptoms include sudden paralysis, altered speech, extreme
irritability or fatigue, and seizures.

Explanation

Polycythemia occurs as a physiological reaction to chronic
hypoxemia which commonly occurs in clients with Tetralogy of Fallot.
Polycythemia and the resultant increased viscosity of the blood increase
the risk of thromboembolic events. Cerebrovascular accidents may occur.
Signs and symptoms include sudden paralysis, altered speech, extreme
irritability or fatigue, and seizures.

27. What would be the primary goal of therapy for a client withpulmonary edema and heart failure?

Increase cardiac output

Peripheral edema decreased

Enhance comfort

Improve respiratory status

The primary goal of therapy for the client with pulmonary edema or heart failure is increasing cardiac output. Pulmonary edema is an acute medical emergency requiring immediate intervention.

Explanation

The primary goal of therapy for the client with pulmonary edema or heart failure is increasing cardiac output. Pulmonary edema is an acute medical emergency requiring immediate intervention.

28. The following are lipid abnormalities. Which of the following is a riskfactor for the development of atherosclerosis and PVD?

High levels of low density lipid (LDL) cholesterol

High levels of high density lipid (HDL) cholesterol

Low concentration triglycerides

Low levels of LDL cholesterol.

An increased in LDL cholesterol concentration has been documented at risk factor for the development of atherosclerosis. LDL cholesterol is not broken down into the liver but is deposited into the wall of the blood vessels.

Explanation

An increased in LDL cholesterol concentration has been documented at risk factor for the development of atherosclerosis. LDL cholesterol is not broken down into the liver but is deposited into the wall of the blood vessels.

29. Joey is a 46 year-old radio technician who is admitted because ofmild chest pain. He is 5 feet, 8 inches tall and weighs 190 pounds. He isdiagnosed with a myocardial infarct. Morphine sulfate, Diazepam (Valium)and Lidocaine are prescribed. The physician orders 8 mg of MorphineSulfate to be given IV. The vial on hand is labeled 1 ml/ 10 mg. Thenurse should administer:

12 minims

8 minims

15 minims

10 minims

Using ratio and proportion 8 mg/10 mg = X minims/15 minims 10 X= 120
X = 12 minims. The nurse will administer 12 minims intravenously
equivalent to 8mg Morphine Sulfate

Explanation

Using ratio and proportion 8 mg/10 mg = X minims/15 minims 10 X= 120
X = 12 minims. The nurse will administer 12 minims intravenously
equivalent to 8mg Morphine Sulfate

30. Mr. Ong, a client with CHF, has been receiving a cardiac glycoside, adiuretic, and a vasodilator drug. His apical pulse rate is 44 and he is onbed rest. The nurse concludes that his pulse rate is most likely the resultof the:

Cardiac glycoside

Vasodilator

Diuretic

Bed-rest regimen

A cardiac glycoside such as digitalis increases force of cardiac contraction, decreases the conduction speed of impulses within the myocardium and slows the heart rate.

Explanation

A cardiac glycoside such as digitalis increases force of cardiac contraction, decreases the conduction speed of impulses within the myocardium and slows the heart rate.

31. The nurse is teaching the patient regarding his permanent artificialpacemaker. Which information given by the nurse shows her knowledgedeficit about the artificial cardiac pacemaker?.

May engage in contact sports

Have regular follow up care

May be allowed to use electrical appliances

Take the pulse rate once a day, in the morning upon awakening

The client should be advised by the nurse to avoid contact
sports. This will prevent trauma to the area of the pacemaker generator.

Explanation

The client should be advised by the nurse to avoid contact
sports. This will prevent trauma to the area of the pacemaker generator.

32. Cardiomyopathy is a serious disease in which the heart muscleweakens and there is an evident change in the cardiac structure. Thereare three types of cardiomyopathy namely: dilated, hypertonic andrestrictive. When assessing a client with left-sided heart failure, thenurse would observe:

Air hunger and tachypnea

Jugular vein distention and neck vein distention

Pitting edema and pulmonary congestion

Ascites and orthopnea

The client with left-sided heart failure usually has pulmonary
congestion, orthopnea, hemoptysis and experiences dyspnea and coughing.
Right sided heart failure is characterized by hepatomegaly, edema, ascites
and distended neck veins. Right sided heart failure is another complication
of cardiomyopathy.

Explanation

The client with left-sided heart failure usually has pulmonary
congestion, orthopnea, hemoptysis and experiences dyspnea and coughing.
Right sided heart failure is characterized by hepatomegaly, edema, ascites
and distended neck veins. Right sided heart failure is another complication
of cardiomyopathy.

33. Electrocardiogarphy (ECG) is a diagnostic tool used to evaluate theelectrical activity of the heart. Which of the following ECG results wouldreveal that there is myocardial ischemia?

ST segment elevation and inverted T wave

ST segment elevation and peaked T wave

ST segment depression and abnormal Q wave

ST segment depression and peaked T wave

The ECG reading of a client who had myocardial ischemia would reveal an inverted T wave and ST segment elevation. The ECG tracing of a client with myocardial injury is characterized by a symmetric and peaked T wave and at least 1 mm ST segment elevation while myocardial infarction will show an abnormal or pathologic Q wave that develops within 1-3 days after MI.

Explanation

The ECG reading of a client who had myocardial ischemia would reveal an inverted T wave and ST segment elevation. The ECG tracing of a client with myocardial injury is characterized by a symmetric and peaked T wave and at least 1 mm ST segment elevation while myocardial infarction will show an abnormal or pathologic Q wave that develops within 1-3 days after MI.

34. A patient has received thromboembolytic therapy following aMyocardial Infarction with Streoptokinase. Which of the following drugsshould the nurse have on hand if the patient develops excessive bleedingor hemorrhage?

Aminocaproic Acid (Amicar)

Protamine Sulfate

Vitamin K

Heparin

The major complication of thromboembolytic therapy is
hemorrhage, and the antidote for this is Amicar, which aids in the
stoppage of bleeding by inhibiting plasminogen, which inhibits
thrombolysis. This drug should be available for any patient on this type
of thromboembolytic therapy. Protamine Sulfate and Vitamin K are the
antidotes for Heparin and Coumadin, respectively. Heparin is not correct,
as it is an anticoagulant.

Explanation

The major complication of thromboembolytic therapy is
hemorrhage, and the antidote for this is Amicar, which aids in the
stoppage of bleeding by inhibiting plasminogen, which inhibits
thrombolysis. This drug should be available for any patient on this type
of thromboembolytic therapy. Protamine Sulfate and Vitamin K are the
antidotes for Heparin and Coumadin, respectively. Heparin is not correct,
as it is an anticoagulant.