Exam 2 MS 1

Where is the point of maximal impulse (PMI) located?

At the apex of the heart in the 5th intercostal space.

What are the three layers of heart tissue?

Endocardium: lining of heart and valves. Myocardium: pumping muscle. Epicardium: protective serous layer.

What is the correct cardiac electrical conduction pathway?

SA node → AV node → Bundle of His → Bundle branches → Purkinje fibers.

What are systole and diastole?

Systole is ventricular contraction (S1, LUB). Diastole is ventricular relaxation (S2, DUB).

How is cardiac output calculated, and what is normal?

CO = stroke volume × heart rate. Normal resting adult cardiac output is approximately 5–6 L/min.

What are preload, afterload, and contractility?

Preload: ventricular stretch at end-diastole. Afterload: resistance to ejection. Contractility: force of myocardial contraction.

Which valves close to produce S1?

The mitral and tricuspid valves close, marking the beginning of ventricular systole.

Which valves close to produce S2?

The aortic and pulmonic valves close, marking the end of ventricular systole.

What can an S4 heart sound indicate?

It occurs before S1 and may be associated with hypertension, coronary artery disease, aortic stenosis, or myopathy.

What causes a heart murmur?

Turbulent blood flow. Systolic murmurs occur between S1 and S2; diastolic murmurs occur between S2 and the next S1.

What does an ECG record?

The heart's electrical activity.

What do depolarization and repolarization mean?

Depolarization activates the heart muscle to contract; repolarization represents electrical recovery associated with relaxation.

What does the P wave represent?

Atrial depolarization, initiated by the SA node.

What does the PR interval represent?

The time associated with conduction of the cardiac impulse from the atria through the AV node toward the ventricles.

What does the QRS complex represent?

Ventricular depolarization.

What do the ST segment, T wave, and QT interval represent?

ST segment: after ventricular depolarization and before repolarization. T wave: ventricular repolarization. QT interval: total time for ventricular depolarization and repolarization.

How can heart rate be estimated using the 6-second ECG method?

Count QRS complexes in 6 seconds and multiply by 10.

A client has a slow heart rate, dizziness, and near-syncope. What is the priority nursing concern?

Determine hemodynamic stability and whether cardiac output is adequate to perfuse vital organs.

What symptoms can indicate symptomatic bradycardia?

Fatigue, shortness of breath, dizziness, chest pain, near-syncope, or altered mental status.

Which causes of bradycardia are listed in the study notes?

Increased intracranial pressure, sleep apnea, hypothyroidism, increased vagal stimulation, decreased metabolic needs, beta blockers, calcium channel blockers, and arrhythmias.

Which laboratory tests may be ordered for bradycardia?

Electrolytes, thyroid panel, troponin, and blood or urine toxicology testing.

What nursing assessments are important for a client with bradycardia?

Monitor vital signs and ECG; assess dizziness, chest pain, dyspnea, mental status, and perfusion to vital organs.

Which medication and dose do the notes list for symptomatic bradycardia?

IV atropine 1 mg; repeat every 3–5 minutes, up to a maximum of 3 mg, according to the notes.

What additional treatment may be needed for symptomatic bradycardia?

Prepare for temporary pacing if indicated.

Why can prolonged tachycardia be dangerous?

It can decrease cardiac output and compromise perfusion to vital organs.

Which causes of tachycardia are listed in the notes?

Pain, fever, stress, anxiety, hypovolemia, fluid volume excess, MI, shock, hyperthyroidism, stimulants, nicotine, caffeine, and certain medications.

What are common manifestations of tachycardia?

Palpitations, dizziness, lightheadedness, chest pain, difficulty breathing, and elevated temperature.

Which findings suggest tachycardia is affecting perfusion?

Hypotension, altered level of consciousness, chest pain, dyspnea, increased respiratory rate, or decreased urine output.

What is the priority nursing approach for a client with tachycardia?

Assess hemodynamic stability, identify the cause, monitor ECG and vital signs, and ensure adequate perfusion.

Which medications for tachycardia are mentioned in the notes?

Adenosine and metoprolol, administered as ordered for the appropriate rhythm and clinical situation.

What nonpharmacologic interventions may help when tachycardia is caused by fever, pain, or anxiety?

Treat the underlying cause by addressing fever, pain, stress, or anxiety.

What are vasovagal maneuvers used for in the notes?

They are taught as an intervention for selected tachycardias when clinically appropriate.

What is catheter ablation?

A procedure that destroys targeted cells responsible for abnormal electrical impulses using heat or cold.

What are premature ventricular contractions (PVCs)?

Early impulses from irritated ventricular cells, commonly producing a wider QRS complex.

What can contribute to PVCs?

Myocardial damage, lung conditions, electrolyte imbalances, caffeine, and alcohol.

What symptoms may occur with PVCs?

Palpitations, shortness of breath, angina, or lightheadedness.

What tests may help evaluate PVCs and contributing factors?

A Holter monitor can record rhythm during daily activities. Blood tests may assess potassium, magnesium, and thyroid levels.

What should the nurse ask when assessing a client with PVCs?

Ask about symptom timing, contributing factors, medication use, caffeine, alcohol, and drug use.

What lifestyle teaching is included for PVCs?

Stop smoking, minimize alcohol, avoid illicit drugs, and reduce caffeine intake.

What are key nursing priorities for a client experiencing PVCs?

Assess pulse, auscultate the heart, monitor vital signs and ECG, evaluate cardiac output, and prepare for electrolyte replacement if ordered.

Which medications for PVCs are listed in the notes?

Beta blockers, antiarrhythmics, flecainide, propafenone, and amiodarone.

When might catheter ablation be considered for PVCs according to the notes?

When medications have not been effective after 30 days, according to the provided notes.

What are premature atrial contractions (PACs)?

Early impulses arising from irritated atrial tissue; they are generally benign.

What ECG changes may occur with PACs?

The P wave may be hidden or unidentifiable, and the PR interval may be shortened or unmeasurable.

What symptoms may a client experience with PACs?

Most clients have no symptoms, although some may feel fluttering in the chest.

What conditions are associated with PACs?

Diabetes mellitus, myocardial infarction, and congestive heart failure may be associated.

What should the nurse assess for when a client has PACs?

Obtain the health history and medication list, gather subjective data, identify possible triggers, and assess whether cardiac output is adequate.

A client with an abnormal rhythm develops hypotension and confusion. What should the nurse prioritize?

Rapidly assess hemodynamic stability and perfusion, monitor vital signs and ECG, and initiate appropriate urgent interventions.

A client’s ECG shows a PR interval greater than 0.20 seconds on every beat, with each P wave followed by a QRS complex. Which rhythm should the nurse suspect?

First-degree AV block. The PR interval is prolonged because conduction from the atria through the AV node is delayed, but every atrial impulse still reaches the ventricles. Nursing priorities: measure the PR interval, assess perfusion, and review medications that prolong the PR interval.

A client with first-degree AV block becomes dizzy and has a history of falls. What is the nurse’s priority?

Assess hemodynamic status and perfusion, obtain vital signs, and institute fall precautions. Dizziness can indicate reduced perfusion and increases fall risk.

Which factors can contribute to first-degree AV block? Select all that apply.

Myocardial infarction, older age, hypokalemia, hypomagnesemia, antiarrhythmics, calcium channel blockers, digoxin toxicity, and athletic conditioning.

A client taking digoxin develops nausea, vomiting, and a prolonged PR interval. What complication should the nurse suspect?

Possible digoxin toxicity. Assess the client, review the ECG and medication history, and notify the provider promptly.

Which ECG measurement is most important when evaluating first-degree AV block?

The PR interval. A PR interval greater than 0.20 seconds on every beat indicates delayed conduction through the AV node.

A client with first-degree AV block is prescribed a medication that can further prolong the PR interval. What should the nurse do?

Review the medication, ECG, heart rate, and perfusion. Clarify or hold the medication only according to orders, protocol, and provider direction.

A nurse assesses a client with atrial fibrillation. Which pulse finding is expected?

An irregular pulse. Atrial fibrillation causes chaotic atrial electrical activity and ineffective atrial contraction.

Why are clients with atrial fibrillation at increased risk for ischemic stroke?

Ineffective atrial contraction can cause blood stasis and clot formation, particularly in the left atrium. A clot can travel to the brain. Anticoagulants reduce clot-related risk.

A client with atrial fibrillation is taking an anticoagulant. Which actions reduce bleeding risk? Select all that apply.

Use bleeding precautions, prevent falls, use care with shaving and toothbrushing, avoid contact sports, and report unusual bleeding.

Which symptoms may occur with atrial fibrillation? Select all that apply.

Irregular pulse, hypotension, palpitations, increased heart rate, chest discomfort, shortness of breath, fatigue, anxiety, dizziness, syncope, weight gain, and increased urination.

A client with atrial fibrillation has hypotension, shortness of breath, and dizziness. What should the nurse assess first?

Assess airway, breathing, vital signs, oxygen saturation, cardiac rhythm, perfusion, and level of consciousness. These findings may indicate hemodynamic instability.

Which diagnostic tests are listed for evaluating atrial fibrillation and possible contributing conditions?

TSH, thyroxine, CBC, glucose, creatinine, INR, platelets, WBC count, echocardiogram, and transesophageal echocardiogram.

What is the purpose of a transesophageal echocardiogram in atrial fibrillation?

To detect blood clots in the left atrium, which is important when evaluating clot-related risk and planning rhythm conversion.

The ECG shows absent distinct P waves with chaotic atrial activity between QRS complexes. Which rhythm is suggested?

Atrial fibrillation. Distinct P waves are replaced by chaotic atrial activity.

A client with atrial fibrillation has a ventricular rate of 140/min. How is this described?

Rapid ventricular response (RVR), because the ventricular rate is greater than 100/min. Assess symptoms, blood pressure, perfusion, and stability.

Which treatments may be used for atrial fibrillation? Select all that apply.

Electrical cardioversion, catheter ablation, anticoagulants, antiarrhythmics, and diet or lifestyle modifications.

Why is an anticoagulant prescribed for atrial fibrillation if it does not correct the rhythm?

Anticoagulants reduce the risk of blood clots and stroke associated with ineffective atrial contraction. They do not directly restore normal sinus rhythm.

Which lifestyle guidance is included for a client with atrial fibrillation?

Discuss lifestyle modifications and avoid stimulants and herbal supplements unless reviewed by the care team, because they may affect rhythm or interact with medications.

The ECG shows a regular rhythm with sawtooth atrial waves and an atrial rate of 240–400/min. Which rhythm is most likely?

Atrial flutter. The characteristic finding is sawtooth-like atrial waves with a rapid atrial rate.

Which symptoms are listed for atrial flutter?

Lightheadedness, palpitations, hypotension, dizziness, chest discomfort, and shortness of breath.

A client with atrial flutter becomes hypotensive and reports chest discomfort. What is the nurse’s priority?

Assess hemodynamic stability, vital signs, oxygen saturation, and perfusion. Promptly escalate care and prepare for prescribed rhythm management, including cardioversion when indicated.

Which nursing actions are emphasized for atrial flutter?

Monitor vital signs and oxygen saturation, assess perfusion, prepare for cardioversion when indicated, administer prescribed anticoagulants or antiarrhythmics, and use bleeding precautions when anticoagulated.

A client suddenly develops a regular narrow-complex tachycardia at 180/min. P waves are not visible. Which rhythm should the nurse suspect?

Supraventricular tachycardia (SVT). It typically has abrupt onset, a regular narrow-complex rhythm, and a rate of about 100–220/min.

A client with SVT is alert and hemodynamically stable. Which intervention may be attempted first as prescribed or directed by protocol?

Vagal maneuvers, such as bearing down while holding the breath. Follow clinical protocol and assess stability.

Which vagal maneuver listed in the notes should only be performed by a physician?

Carotid sinus massage. The notes caution against it in clients with a history of stroke.

A client with SVT is prescribed rapid IV adenosine. What dose sequence is listed in the study notes?

The notes list 6 mg IV over 1–3 seconds followed by a 20 mL normal saline flush. If there is no change, they list a repeat 12 mg dose followed by a 20 mL flush. Follow current orders and institutional protocol.

What safety preparation is emphasized when administering IV adenosine for SVT?

Have a defibrillator available and continuously monitor the cardiac rhythm and client because adenosine can cause transient rhythm changes.

A client with SVT becomes hypotensive and loses consciousness. What is the priority?

Treat as hemodynamic instability. Activate emergency response, assess pulse and breathing, and prepare for emergency rhythm management, including synchronized cardioversion when indicated.

Which medications besides adenosine are listed as possible SVT treatments?

IV diltiazem, IV esmolol, and IV metoprolol. Monitor heart rate, blood pressure, rhythm, and perfusion.

Which findings can be associated with SVT? Select all that apply.

Sudden palpitations, dizziness, lightheadedness, syncope, shortness of breath, hypotension, and increased fall risk.

What is coronary artery disease (CAD)?

Plaque buildup in the coronary arteries that decreases blood flow and oxygen delivery to the heart muscle. It can cause angina, acute coronary syndromes, heart failure, and arrhythmias.

A client reports chest pressure during exercise that improves with rest. Which condition does this pattern suggest?

Stable angina. It occurs when the heart needs more oxygen than narrowed coronary arteries can supply, often during activity, and typically improves with rest.

A client reports new chest pain while resting. Why is this more concerning than usual exertional chest pain?

Chest pain at rest can indicate unstable angina or acute coronary syndrome. Treat new or worsening chest pain as urgent and obtain prompt assessment.

How do the study notes distinguish NSTEMI from unstable angina?

NSTEMI has elevated cardiac markers, especially troponin. Unstable angina does not have the same elevation in cardiac markers. Both require urgent evaluation.

What causes a STEMI according to the study notes?

An abrupt disruption of blood flow to an area of the heart, resulting in acute injury to heart muscle. This is a medical emergency.

A client has chest pressure radiating to the left arm and jaw. What should the nurse suspect and do?

Suspect myocardial ischemia or acute coronary syndrome. Promptly assess vital signs and symptoms, obtain or facilitate an ECG and ordered cardiac biomarkers, and activate the facility’s chest-pain protocol.

Which classic angina descriptions are included in the CAD notes?

Tightness, fullness, or pressure in the mid-sternum, possibly radiating to the left arm, neck, jaw, or back. Stable angina occurs with activity, while unstable angina may occur at rest.

A client with diabetes is being assessed for possible MI but denies chest pain. Why should the nurse remain concerned?

Women, older adults, and people with diabetes may have an MI without chest pain. Assess for other concerning symptoms and follow diagnostic protocols.

What does an elevated troponin level indicate?

Cardiac muscle injury. Troponin I and T may become detectable around four hours after injury. Higher levels generally indicate greater myocardial damage, and serial levels may be needed.

A client’s first troponin is not elevated, but symptoms began recently and MI is still suspected. What is an appropriate nursing consideration?

Do not rule out myocardial injury based on one early result. Obtain repeat troponin levels as ordered because the marker may not rise immediately.

Which laboratory tests are listed in the CAD study notes?

Cholesterol, homocysteine, C-reactive protein, troponin I and T, and CK-MB. Interpret results in the full clinical context.

What is the role of cholesterol testing in a client with CAD?

It helps assess a cardiovascular risk factor. Elevated cholesterol can contribute to atherosclerotic disease risk.

What does C-reactive protein help detect according to the study notes?

Inflammation. It may contribute to cardiovascular risk assessment but does not independently diagnose an acute MI.

Which risk factors for CAD are listed in the study notes? Select all that apply.

Sedentary lifestyle, personal or family history, lack of sleep, hypertension, diabetes, race, elevated homocysteine, lupus, smoking, obesity, stress, and increasing age.

A nurse is obtaining a history from a client with CAD. Which topics are emphasized in the notes?

Activity and lifestyle habits, occupation and related exposures or stress or irregular hours, family history of CAD, and current medications.

Which diagnostic procedures are listed in the CAD notes?

ECG, cardiac catheterization, exercise stress testing, stress ECG, nuclear stress testing, and chest X-ray.

What is the purpose of cardiac catheterization in CAD?

It allows clinicians to evaluate coronary arteries and, when indicated, treat a blockage.

What can a chest X-ray reveal in a client being evaluated for CAD-related complications?

It may show an enlarged heart, which can be associated with cardiomyopathy or heart failure, and may show fluid in the lungs. It does not directly show coronary artery plaque.

A client with CAD develops worsening shortness of breath and weight gain. What complication should the nurse consider?

Possible worsening heart failure or fluid retention. Assess respiratory status, oxygen saturation, vital signs, weight trend, and signs of fluid overload, then report concerning findings.

A client with suspected acute coronary syndrome has chest pressure and shortness of breath. Which assessment priorities are appropriate?

Assess airway, breathing, vital signs, oxygen saturation, pain characteristics and radiation, cardiac rhythm, and perfusion. Promptly initiate the chest-pain protocol and facilitate ECG and ordered biomarkers.

Why can untreated CAD lead to arrhythmias and heart failure?

Persistent reduced blood flow and oxygen delivery can damage or weaken the heart muscle, contributing to impaired pumping and abnormal electrical activity.

Which pairing of ECG clues and rhythms is correct?

Atrial fibrillation: absent distinct P waves and chaotic atrial activity. Atrial flutter: sawtooth-like atrial waves and atrial rate around 240–400/min. SVT: regular narrow-complex tachycardia with abrupt onset and often no visible P waves.