Cardiovascular System | Myocardial Infarction and Heart Failure NCLEX Quiz 17

1. A nurse caring for a client in one room is told by another nurse that a second client has developed severe pulmonary edema. On entering the 2nd client's room. the nurse would expect the client to be:

Slightly anxious

Mildly anxious

Moderately anxious

Extremely anxious

Pulmonary edema causes the client to be extremely agitated and anxious. The client may complain of a sense of drowning. suffocation. or smothering.

Explanation

Pulmonary edema causes the client to be extremely agitated and anxious. The client may complain of a sense of drowning. suffocation. or smothering.

2. A client who had cardiac surgery 24 hours ago has a urine output averaging 19 ml/hr for 2 hours. The client received a single bolus of 500 ml of IV fluid. Urine output for the subsequent hour was 25 ml. Daily laboratory results indicate the blood urea nitrogen is 45 mg/dL and the serum creatinine is 2.2 mg/dL. A nurse interprets the client is at risk for:

Hypovolemia

UTI

Glomerulonephritis

Acute renal failure

The client who undergoes cardiac surgery is at risk for renal injury from poor perfusion. hemolysis. low cardiac output. or vasopressor medication therapy. Renal insult is signaled by decreased urine output and increased BUN and creatinine levels. The client may need medications such as dopamine (Intropin) to increase renal perfusion and possibly could need peritoneal dialysis or hemodialysis.

Explanation

The client who undergoes cardiac surgery is at risk for renal injury from poor perfusion. hemolysis. low cardiac output. or vasopressor medication therapy. Renal insult is signaled by decreased urine output and increased BUN and creatinine levels. The client may need medications such as dopamine (Intropin) to increase renal perfusion and possibly could need peritoneal dialysis or hemodialysis.

3. A client with pulmonary edema has been on diuretic therapy. The client has an order for additional furosemide (Lasix) in the amount of 40 mg IV push. Knowing that the client also will be started on Digoxin (Lanoxin). a nurse checks the client's most recent:

Digoxin level

Sodium level

Potassium level

Creatinine level

The serum potassium level is measured in the client receiving digoxin and furosemide. Heightened digitalis effect leading to digoxin toxicity can occur in the client with hypokalemia. Hypokalemia also predisposes the client to ventricular dysrhythmias.

Explanation

The serum potassium level is measured in the client receiving digoxin and furosemide. Heightened digitalis effect leading to digoxin toxicity can occur in the client with hypokalemia. Hypokalemia also predisposes the client to ventricular dysrhythmias.

4. A client's electrocardiogram strip shows atrial and ventricular rates of 80 complexes per minute. The PR interval is 0.14 second. and the QRS complex measures 0.08 second. The nurse interprets this rhythm is:

Normal sinus rhythm

Sinus bradycardia

Sinus tachycardia

Sinus dysrhythmia

The client's electrocardiogram strip shows a normal sinus rhythm because the atrial and ventricular rates are within the normal range of 60-100 complexes per minute. The PR interval is also within the normal range of 0.12-0.20 seconds, indicating normal conduction from the atria to the ventricles. The QRS complex duration is also normal, measuring 0.08 seconds. Therefore, all the parameters of the electrocardiogram are within normal limits, indicating a normal sinus rhythm.

Explanation

The client's electrocardiogram strip shows a normal sinus rhythm because the atrial and ventricular rates are within the normal range of 60-100 complexes per minute. The PR interval is also within the normal range of 0.12-0.20 seconds, indicating normal conduction from the atria to the ventricles. The QRS complex duration is also normal, measuring 0.08 seconds. Therefore, all the parameters of the electrocardiogram are within normal limits, indicating a normal sinus rhythm.

5. A client has frequent bursts of ventricular tachycardia on the cardiac monitor. A nurse is most concerned with this dysrhythmia because:

It is uncomfortable for the client. giving a sense of impending doom.

It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia.

It is almost impossible to convert to a normal sinus rhythm.

It can develop into ventricular fibrillation at any time.

Ventricular tachycardia is a life-threatening dysrhythmia that results from an irritable ectopic focus that takes over as the pacemaker for the heart.Option A: Client’s frequently experienced a feeling of impending death. Ventricular tachycardia is treated with antiarrhythmic medications or magnesium sulfate. cardioversion (client awake). or defibrillation (loss of consciousness).Option B: The low cardiac output that results can lead quickly to cerebral and myocardial ischemia.Option D: Ventricular tachycardia can deteriorate into ventricular fibrillation at any time.

Explanation

Ventricular tachycardia is a life-threatening dysrhythmia that results from an irritable ectopic focus that takes over as the pacemaker for the heart.Option A: Client’s frequently experienced a feeling of impending death. Ventricular tachycardia is treated with antiarrhythmic medications or magnesium sulfate. cardioversion (client awake). or defibrillation (loss of consciousness).Option B: The low cardiac output that results can lead quickly to cerebral and myocardial ischemia.Option D: Ventricular tachycardia can deteriorate into ventricular fibrillation at any time.

6. A home care nurse is making a routine visit to a client receiving digoxin (Lanoxin) in the treatment of heart failure. The nurse would particularly assess the client for:

Thrombocytopenia and weight gain

Anorexia. nausea. and visual disturbances

Diarrhea and hypotension

Fatigue and muscle twitching

The first signs and symptoms of digoxin toxicity in adults include abdominal pain. N/V. visual disturbances (blurred. yellow. or green vision. halos around lights). bradycardia. and other dysrhythmias.

Explanation

The first signs and symptoms of digoxin toxicity in adults include abdominal pain. N/V. visual disturbances (blurred. yellow. or green vision. halos around lights). bradycardia. and other dysrhythmias.

7. The physician orders continuous intravenous nitroglycerin infusion for the client with MI. Essential nursing actions include which of the following?

Obtaining an infusion pump for the medication

Monitoring BP q4h

Monitoring urine output hourly

Obtaining serum potassium levels daily

IV nitro infusion requires an infusion pump for precise control of the medication.Option B: BP monitoring would be done with a continuous system. and more frequently than every 4 hours.Option C: Hourly urine outputs are not always required.Option D: Obtaining serum potassium levels is not associated with nitroglycerin infusion.

Explanation

IV nitro infusion requires an infusion pump for precise control of the medication.Option B: BP monitoring would be done with a continuous system. and more frequently than every 4 hours.Option C: Hourly urine outputs are not always required.Option D: Obtaining serum potassium levels is not associated with nitroglycerin infusion.

8. Aspirin is administered to the client experiencing an MI because of its:

Antipyretic action

Antithrombotic action

Antiplatelet action

Analgesic action

Aspirin does have antipyretic. antiplatelet. and analgesic actions. but the primary reason ASA is administered to the client experiencing an MI is its antithrombotic action.

Explanation

Aspirin does have antipyretic. antiplatelet. and analgesic actions. but the primary reason ASA is administered to the client experiencing an MI is its antithrombotic action.

9. A nurse is preparing to ambulate a client on the 3rd day after cardiac surgery. The nurse would plan to do which of the following to enable the client to best tolerate the ambulation?

Encourage the client to cough and deep breathe

Premedicate the client with an analgesic

Provide the client with a walker

Remove telemetry equipment because it weighs down the hospital gown.

The nurse should encourage regular use of pain medication for the first 48 to 72 hours after cardiac surgery because analgesia will promote rest. decrease myocardial oxygen consumption resulting from pain. and allow better participation in activities such as coughing. deep breathing. and ambulation.Options A and C will not help in tolerating ambulation.Option D: Removal of telemetry equipment is contraindicated unless prescribed.

Explanation

The nurse should encourage regular use of pain medication for the first 48 to 72 hours after cardiac surgery because analgesia will promote rest. decrease myocardial oxygen consumption resulting from pain. and allow better participation in activities such as coughing. deep breathing. and ambulation.Options A and C will not help in tolerating ambulation.Option D: Removal of telemetry equipment is contraindicated unless prescribed.

10. A client with angina complains that the angina pain is prolonged and severe and occurs at the same time each day. most often in the morning. On further assessment a nurse notes that the pain occurs in the absence of precipitating factors. This type of anginal pain is best described as:

Stable angina

Unstable angina

Variant angina

Nonanginal pain

Variant angina. or Prinzmetal’s angina. is prolonged and severe and occurs at the same time each day. most often in the morning.Option A: Stable angina is induced by exercise and is relieved by rest or nitroglycerin tablets.Option B: Unstable angina occurs at lower and lower levels of activity and rest. is less predictable and is often a precursor of myocardial infarction.

Explanation

Variant angina. or Prinzmetal’s angina. is prolonged and severe and occurs at the same time each day. most often in the morning.Option A: Stable angina is induced by exercise and is relieved by rest or nitroglycerin tablets.Option B: Unstable angina occurs at lower and lower levels of activity and rest. is less predictable and is often a precursor of myocardial infarction.

Cardiovascular System | Myocardial Infarction And Heart Failure NCLEX Quiz 17