Alterations in Cardiovascular Function and Perfusion Assessment

A nurse is teaching a client about reducing risk factors for coronary artery disease (CAD). Which of the following client statements indicates to the nurse understanding of the teaching?

"I will follow a moderate exercise regimen."

The nurse should teach the clients to follow a moderate exercise regimen as inactivity increases the risk of CAD.

A nurse is assessing a client who has coronary artery disease. Which of the following manifestations should the nurse identify as needing immediate intervention? (SATA)

Angina is correct. Angina is a manifestation of coronary artery disease and are caused by decreased blood flow and oxygen to the myocardium.

Shortness of breath is correct. Shortness of breath is a manifestation of coronary artery disease.

Diaphoresis is correct. Diaphoresis is a manifestation of coronary artery disease.

Nausea is correct. Nausea is a manifestation of coronary artery disease.

A nurse is teaching a group of clients about risk factors for developing coronary artery disease (CAD). Which of the following should the nurse include in the teaching? (SATA)

High levels of stress is correct. Stress, diabetes mellitus, family history of CAD, hypertension, and hyperlipidemia are risk factors for the development of coronary artery disease.

Diabetes mellitus is correct. Stress, diabetes mellitus, family history of CAD, hypertension, and hyperlipidemia are risk factors for the development of coronary artery disease.

Family history of CAD is correct. Stress, diabetes mellitus, family history of CAD, hypertension, and hyperlipidemia are risk factors for the development of coronary artery disease.

Hypertension is correct. Stress, diabetes mellitus, family history of CAD, hypertension, and hyperlipidemia are risk factors for the development of coronary artery disease.

Hyperlipidemia is correct. Stress, diabetes mellitus, family history of CAD, hypertension, and hyperlipidemia are risk factors for the development of coronary artery disease.

A nurse is teaching a client who has hypertrophic cardiomyopathy (HCM) about the cause of the condition. Which of the following statements should the nurse include in the teaching?

"Your heart condition is caused by thickening of the ventricular walls and septum."

Hypertrophic cardiomyopathy (HCM) is a cardiac disorder that results from hypertrophy or thickening of the left ventricular walls and septum.

A nurse is presenting an in-service to nursing staff on heart failure. Which of the following risk factors for heart disease should the nurse identify as the result of structural changes to the heart?

Hypertension

The nurse should identify that structural changes to the heart as a result of conditions such as congenital heart disease, myocarditis, and hypertension increase the risk for heart failure.

A nurse is providing discharge teaching to a client who has atrial fibrillation (A-fib) about prevention of complications. Which of the following should the nurse include in the teaching?

Avoid taking over-the-counter decongestants

Over-the-counter decongestants can increase the risk of dysrhythmias in clients who have a-fib.

A nurse is teaching a group of clients about risk factors for developing chronic venous disease. Which of the following risk factors should the nurse include in the teaching?

Standing for prolonged periods of time

Standing for prolonged periods of time is a risk factor for chronic venous disease. This should be included in the teaching.

A nurse is analyzing a client's electrocardiogram (ECG) strip and identifies the following information:

HR: 145

Rhythm: Regular

P wave indiscernible

QRS duration 0.06 seconds

Based upon this information, the nurse will interpret the client's rhythm as which of the following?

Supraventricular tachycardia (SVT)

SVT analysis should determine an increased heart rate and a narrow QRS complex measurement.

A nurse is teaching a group of clients about modifiable risk factors for developing valvular dysfunction. Which of the following risk factors should the nurse include in the teaching?

Hypertension

Hypertension is a risk factor for developing valvular dysfunction and is a modifiable risk factor that the client can change.

A nurse is reviewing laboratory results for a client who has a cardiomyopathy. Which of the following blood tests should the nurse anticipate the provider prescribing to evaluate cardiomyopathy severity?

Brain natriuretic peptide (BNP)

Elevated BNP levels would be an expected lab for clients who have cardiomyopathy or congestive heart failure. This lab test indicates stretching of the ventricles from fluid overload.

A nurse is teaching a client who has coronary artery disease (CAD) about prevention of progression of the disease. Which of the following lifestyle modifications should the nurse include in the teaching?

Controlling of hypertension

Reducing or controlling hypertension is a lifestyle modification indicated for clients who have CAD. Reducing hypertension, along with other lifestyle modifications, can help decrease or avoid recurrence of CAD and its progression.

A nurse is analyzing a client's electrocardiogram (ECG) strip and identifies the following information:

HR: 75 bpm

Rhythm: Regular

P wave: One before each WRS complex

PR interval: 0.16 seconds

QRS duration: 0.10 seconds

Based upon this information, the nurse will interpret the client's rhythm as which of the following?

Normal sinus rhythm (NSR)

The information identified from the ECG analysis is within the normal ECG analysis parameters.

A nurse is reviewing the medical history of a client who has heart failure. Which of the following client conditions should the nurse understand contributes to heart failure? SATA

Thyrotoxicosis is correct. Thyrotoxicosis, anemia, hypertension, and thiamine deficiency are risk factors for heart failure.

Anemia is correct. Thyrotoxicosis, anemia, hypertension, and thiamine deficiency are risk factors for heart failure.

Hypertension is correct. Thyrotoxicosis, anemia, hypertension, and thiamine deficiency are risk factors for heart failure.

Thiamine deficiency is correct. Thyrotoxicosis, anemia, hypertension, and thiamine deficiency are risk factors for heart failure.

A nurse is caring for a client who has a coronary artery disease that has progressed to an ST elevation myocardial infarction (STEMI). Which of the following procedures should the nurse anticipate for this client?

Heart catheterization and percutaneous intervention

The American Heart Association recommends a cardiac catheterization and percutaneous intervention within 90 minutes or less.

A nurse is assessing a client who has valvular dysfunction. Which of the following client statements should indicate to the nurse that this condition is affecting the client's ability to perform activities of daily living (ADLs)?

"I get short of breath when I make my bed."

Clients with valvular dysfunction are at risk for fluid overload. The inability to make their bed without exhibiting shortness of breath indicates the client is unable to complete their ADLs.

A nurse is preparing to administer medications to a client with peripheral artery disease. Which of the following medications should the nurse anticipate administering? SATA

Cilostazol is correct. Cilostazol would be administered to a client with peripheral artery disease to cause vasodilation and for its antiproliferative effects.

Pentoxifylline is correct. Pentoxifylline would be administered to a client with peripheral artery disease to improve claudication.

A nurse is assessing a client who has acute pericarditis. Which of the following manifestations should the nurse anticipate? SATA

Hiccups is correct. Hiccups are a manifestation of pericarditis and is caused by the irritation and inflammation that occur due to the heart’s constant motion.

Dysphagia is correct. Dysphagia or difficulty swallowing is a manifestation of pericarditis and is caused by the irritation and inflammation that occur due to the heart’s constant motion.

Chest pain is correct. Chest pain is a manifestation of pericarditis and are caused from the irritation and inflammation that occur due to the heart’s constant motion.

A nurse is reviewing laboratory results for a client who has heart failure. Which of the following blood tests should the nurse understand will evaluate the severity of heart failure and risk of death?

B-type natriuretic peptide (BNP)

Elevated BNP levels should be an expected lab for clients who have heart failure. This lab test corresponds with the New Your Heart Association Classification system and is a strong predictor of readmission and the risk of death at discharge.

A nurse is preparing to analyze a client's electrocardiogram (ECG) strip. Place the following steps the nurse should take in order from first to last.

Calculating heart rate is the first step in the process of analyzing ECG strips. Determining if the rhythm is regular is the second step in the process of analyzing ECG strips. Assessing for P waves is the third step in the process of analyzing ECG strips. Measuring the PR interval is the fourth step in the process of analyzing ECG strips. Measuring duration of QRS complex is the fifth step in the process of analyzing ECG strips. Observing for changes in T waves in the final step in the process of analyzing ECG strips.

A nurse is assisting in caring for a client who has chronic venous disease, and the client asks why their legs have been swelling and feel so heavy at times. Which of the following statements should the nurse include?

"Damaged or occluded veins cause blood to pool in the legs instead of returning to the heart."

Instead of the deoxygenated blood returning to the heart, it pools in the legs and causes the veins to become dilated and weak. When the valves do not work properly, blood pools in the veins and causes pressure in the venous system to rise. If the pressure is not resolved, it leads to vein distention and varicose veins.

A nurse is teaching a group of clients about chronic health conditions that increase the risk for developing premature ventricular contractions (PVCs). Which of the following should the nurse include in the teaching?

Myocardial infarction that required stent placement.

A history of recent myocardial infarction, cardiac surgery, or other cardiac diseases that cause damage to the cardiac muscle increases the risk for developing PVCs.

A nurse is providing discharge teaching to a client who has cardiomyopathy. Which of the following should the nurse include in the teaching? SATA

Restrict fluids to approximately 2 liters each day is correct. Fluid restriction to 2 liters a day, limiting dietary intake of sodium, checking weight every morning, and reporting ankle edema are lifestyle modifications indicated for clients who have cardiomyopathy or heart failure to decrease fluid retention.

Limit dietary intake of sodium is correct. Fluid restriction to 2 liters a day, limiting dietary intake of sodium, checking weight every morning, and reporting ankle edema are lifestyle modifications indicated for clients who have cardiomyopathy or heart failure to decrease fluid retention.

Check weight every morning is correct. Fluid restriction to 2 liters a day, limiting dietary intake of sodium, checking weight every morning, and reporting ankle edema are lifestyle modifications indicated for client’s who have cardiomyopathy or heart failure to decrease fluid retention.

Report ankle edema is correct. Fluid restriction to 2 liters a day, limiting dietary intake of sodium, checking weight every morning, and reporting ankle edema are lifestyle modifications indicated for client’s who have cardiomyopathy or heart failure to decrease fluid retention.

A nurse is teaching a client about the pathophysiology of valvular regurgitation. Which of the following statements by the nurse indicates that the client understands the pathophysiology of valvular regurgitation?

"The valve is not closing completely. Blood in the heart is backing up from one chamber of the heart to another chamber due to the valve not completely closing."

Regurgitation occurs when the valves do not close completely and blood backs up into the chamber from which it came.

A nurse is assessing a client who has arterial fibrillation. Which of the following client statements by the client should indicate to the nurse that this condition is affecting the client's ability to perform activities of daily living (ADLs)?

"I feel pressure in my chest when I climb stairs."

The inability to climb stairs without experiencing heart palpitations or chest heaviness indicates intolerance to exercise for clients who have a-fib.

A nurse is providing discharge teaching to a client who has supraventricular tachycardia (SVT). Which of the following should the nurse include in the teaching?

Evaluate potential fall risks in the home environment.

Clients who have SVT or PSVT may experience dizziness, lightheadedness, or syncope. If the client is symptomatic, they have an increased risk of falls and should evaluate potential causes of falls in their home.

A nurse is providing discharge teaching to a client who has heart failure. Which of the following instructions should the nurse include in the teaching?

Maintain six feet between oxygen and an open flame.

Clients should be taught to maintain six feet between the oxygen and any open flame.

A nurse is reviewing diagnostic tests for a client who has peripheral artery disease. Which of the following ankle-brachial index results (ABI) should the nurse understand indicates peripheral artery disease?

ABI ratio of 0.7

An abnormal ABI would be present in a client with peripheral artery disease. It confirms the assessment finding of decreased or absent pulses in the lower extremities. The normal ABI ratio is 0.9-1.2

A nurse is caring for a client who has dilated cardiomyopathy. Which of the following interventions should the nurse implement with this client? SATA

Nurses' Notes

1920:Awake, alert, oriented x 3. Skin warm and dry. Lung sounds with crackles bilaterally throughout. Oxygen saturation is 88% on 4 L/min via nasal cannula. Telemetry reveals sinus tachycardia, rate 125/min. Lower extremities with 3+ pitting edema. Reports increasing shortness of breath with ambulation and activities. Noted urine output for previous 24 hr 575 mL.

Laboratory Results

1930: Brain Natriuretic Peptide 1050 pg/mL (less than 100 pg/mL)

Provider Prescriptions

1200: Increase valsartan to 80 mg dailyTitrate oxygen for oxygen saturation greater than 95%Administer IV nitroglycerine for BNP greater than 1,000 pg/mLAdminister furosemide 80 mg intravenous push for urine output less than 720 mL/24 hr

- Administer furosemide 80 mg intravenous push

- Increase supplemental oxygen

- Administer intravenous infusion of nitroglycerin

When recognizing cues, the nurse should identify that the client is experiencing worsening of dilated cardiomyopathy manifestations including increased shortness of breath, decreased oxygen saturation with oxygen therapy, lower extremity edema, and decreased urine output. These manifestations indicate a decreased cardiac output and increased fluid volume overload. The nurse should recognize that the client will require the administration of furosemide 80 mg intravenous push, intravenous nitroglycerin, and an increase in supplement oxygen for oxygen saturation less than 95%.

A nurse is caring for a client who has pericarditis.

Based on the assessment findings, which of the following lab tests should the nurse anticipate will have abnormal results? SATA

Laboratory Results

WBC 12,000/mm3 (5,000 to 10,000/mm3​​)

Neutrophil 76% (55% to 70%)

Lymphocytes 28% (20% to 40%)

Monocytes 4% (2% to 8%)

Eosinophils 3% (1% to 4%)

Basophils 0.5% (0.5% to 1%)

Red blood cell count 5.4 million/mm3 (4.2 to 6.1 million/mm3 male)

Hemoglobin 14 g/dL (14 to 18 g/dL male)

Hct 47% (42% to 52% male)

Platelet count 280,000/mm3 (150,000 to 400,000/mm3)

C-Reactive protein 11.2 mg/L (less than 10 mg/L)

Erythrocyte sedimentation rate (ESR) 39 mm/hr (up to 15 mm/hr male)

Serum electrolytes

Sodium 142 mEq/L (136 to 145 mEq/L)

Potassium 3.5 mEq/L (3.5 to 5 mEq/L)

Chloride 103 mEq/L (98 to 106 mEq/L)

Glucose 114 mg/dL (74 to 106 mg/dL)

- White blood cell count (WBC)

- Erythrocyte sedimentation rate (ESR)

- C-reactive protein (CRP)

When recognizing cues, the nurse should identify that the findings of low-grade fever with body chills, reports of dizziness, hiccups, pericardial friction rub, chest pain, and difficulty swallowing indicate worsening of pericarditis. The nurse should expect laboratory results from the white blood cell count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) to be elevated from inflammatory processes consistent with pericarditis.

A nurse is caring for a client who is experiencing heart palpitations.

Which of the following interventions should the nurse include in the plan of care for this client? SATA

Nurses' Notes

2000:

The client was admitted for cardiac monitoring. The client reports occasional heart palpitations. Skin warm and dry. ECG reveals sinus tachycardia with heart rate 106/min. Heart sounds regular. Lung sounds clear to auscultation. Bowel sounds normoactive in all quadrants.

2345:

The client reports sudden onset of shortness of breath, respiratory rate 26/min, diaphoresis, chest pressure, and feeling lightheaded. ECG reveals SVT with a heart rate of 180/min. Oxygen saturation 86%.

- Have the client bear down as if for a bowel movement

- Ask the client to cough forcefully

When generating solutions, the nurse should identify that the client is experiencing symptomatic supraventricular tachycardia (SVT) and that immediate vasovagal maneuvers are required to attempt convert the heart rhythm and stabilize the client. These may include vagal maneuvers such as forceful coughing, gagging, or valsalva maneuvers such as bearing down like having a bowel movement.