PrepU Cardiac ❤️

acute coronary syndrome:

a constellation of signs and symptoms due to the rupture of atherosclerotic plaque and resultant partial or complete thrombosis within a diseased coronary artery

murmurs:

sounds created by abnormal, turbulent flow of blood in the heart

S1:

the first heart sound produced by closure of the atrioventricular (mitral and tricuspid) valves

S2

the second heart sound produced by closure of the semilunar (aortic and pulmonic) valves

S3

S3: an abnormal heart sound detected early in diastole as resistance is met to blood entering either ventricle; most often due to volume overload associated with heart failure

S4

S4: an abnormal heart sound detected late in diastole as resistance is met to blood entering either ventricle during atrial contraction; most often caused by hypertrophy of the ventricle

premature atrial complex occurs when

occurs when an electrical impulse starts in the atrium before the next normal impulse of the sinus node

what does a premature atrial complex look like on ecg

An early and different P wave may be seen or may be hidden in the T wave; other P waves in the strip are consistent

Afib ECG

Atrial rate is 300 to 600 bpm; ventricular rate is usually 120 to 200 bpm in untreated atrial fibrillation

Ventricular and atrial rhythm: Highly irregular

QRS shape and duration: Usually normal, but may be abnormal

P wave: No discernible P waves; irregular undulating waves that vary in amplitude and shape are seen and referred to as fibrillatory or f waves

PR interval: Cannot be measured

Atrial flutter

occurs because of a conduction defect in the atrium and causes a rapid, regular atrial impulse at a rate between 250 and 400 bpm. Because the atrial rate is faster than the AV node can conduct, not all atrial impulses are conducted into the ventricle, causing a therapeutic block at the AV node

Which term describes the amount of blood ejected per heartbeat?

stroke volume

A client has been admitted to the intensive care unit (ICU) after an ischemic stroke, and a central venous pressure (CVP) monitoring line was placed. The nurse notes a low CVP. Which condition is the most likely reason for a low CVP?

hypovolemia

The nurse is conducting client teaching about cholesterol levels. When discussing the client’s elevated LDL and lowered HDL levels, the client shows an understanding of the significance of these levels by making what statement?

"Increased LDL and decreased HDL increase my risk of coronary artery disease."

A client who experienced a myocardial infarction (MI) is told that their heart no longer pumps effectively. When asked, the nurse explains that the damage has affected what layer of the heart?

myocardium

The nurse is caring for a client admitted with unstable angina. The laboratory result for the initial troponin I is elevated in this client. The nurse should recognize what implication of this assessment finding?

This is an accurate indicator of myocardial injury.

The results of a high-sensitivity C-reactive protein (hs-CRP) will allow the nurse to evaluate the role of what process implicated in the development of atherosclerosis?

inflammation

The nurse observes a client during an exercise stress test (bicycle). Which finding indicates a positive test and the need for further diagnostic testing?

ST-segment changes on the ECG

The nurse is preparing a client for transesophageal echocardiography (TEE). This procedure is used for which indication?

determination of atrial thrombi

A nurse is preparing a client for an exercise stress test the following morning. Which client statement indicates a need for additional teaching?

"I won't eat or drink anything after midnight tonight."

A client scheduled for cardiac catheterization is anxious and asks the nurse the reason for this test. What is the nurse’s best response?

“Cardiac catheterization is usually done to assess how blocked or open a client’s coronary arteries are.”

A client with a complex cardiac history is scheduled for transthoracic echocardiography. What should the nurse teach the client in anticipation of this diagnostic procedure?

The test is noninvasive, and nothing will be inserted into the client's body.

Each chamber of the heart has a particular role in maintaining cellular oxygenation. Which chamber is responsible for receiving oxygenated blood from the lungs?

left atrium

The nurse is assessing a client’s blood pressure. What does the nurse document as the difference between the systolic and the diastolic pressure?

pulse pressure

The nurse is caring for a client whose stroke volume has increased. The nurse is aware that afterload influences a client's stroke volume, and recognizes that an increase in afterload is triggered by what event?

Arterial vasoconstriction

The nurse cares for a client in the ICU diagnosed with coronary artery disease (CAD). Which assessment data indicates the client is experiencing a decrease in cardiac output?

disorientation, 20 mL of urine over the last 2 hours

A critical care nurse is caring for a client with a hemodynamic monitoring system in place. For what complications should the nurse assess?

pneumothroax, air embolism, infection

The nursing instructor is teaching nursing students about myocardial contractility and ejection fractions. What diagnostic tests can determine client ejection fractions?

• Echocardiogram

• Cardiac catheterization

• Magnetic resonance imaging

A client is brought into the ED by family members who tell the nurse the client grabbed their chest and reported substernal chest pain. What form of monitoring should the nurse anticipate being implemented?

Hardwire continuous electrocardiogram (ECG) monitoring

A nurse will use what term to describe the process by which blood is ejected into circulation as the chambers of the heart become smaller?

systole

The nurse is aware that electrical conduction of the heart usually originates in the SA node and then proceeds in what sequence?

SA node to AV node to bundle of HIS to Purkinje fibers

A nurse is caring for a client who experienced an MI. The client is ordered to receive metoprolol. The nurse understands that this medication has which therapeutic effect?

decreasing HR

A client is admitted for treatment of Prinzmetal angina. When developing this client's care plan, the nurse should keep in mind that this type of angina is a result of what trigger?

Coronary artery spasm.

A nurse should obtain serum levels of which electrolytes in a client with frequent episodes of ventricular tachycardia?

magnesium and potassium

The nurse recognizes that the treatment for a non-ST-elevation myocardial infarction (NSTEMI) differs from that for a STEMI, in that a STEMI is more frequently treated with

percutaneous coronary intervention (PCI).

The nurse is participating in the care conference for a client with ACS. What goal should guide the care team's selection of assessments, interventions, and treatments?

Balancing myocardial oxygen supply with demand

A client is prescribed a nitroglycerin transdermal patch to treat angina. Which statement does the nurse include when reinforcing medication teaching to the client prior to discharge?

“The patch should be worn for 12 hours and then removed for 12 hours.”

A client’s electrocardiogram reveals an irregular rhythm of 75 bpm with a normal QRS and P wave. The nurse who is caring for the client should anticipate:

no immediate treatment

A client with chest pain arrives in the emergency department and receives nitroglycerin, morphine, oxygen, and aspirin. The health care provider diagnoses acute coronary syndrome. When the client arrives on the unit, vital signs are stable and the client does not report any pain. In addition to the medications already given, which medication does the nurse expect the health care provider to order?

a beta blocker (ex Carvedilol)

A client with a history of mitral stenosis is admitted to the intensive care unit (ICU) with the abrupt onset of atrial fibrillation. The client’s heart rate ranges from 120 to 140 bpm. The nurse recognizes that interventions are implemented to prevent the development of

embolic stroke

A client who is a candidate for an implantable cardioverter defibrillator (ICD) asks the nurse about the purpose of this device. What would be the nurse's best response?

“To detect and treat dysrhythmias such as ventricular fibrillation and ventricular tachycardia.”

After 2-hour onset of acute chest pain, the client is brought to the emergency department for evaluation. Elevation of which diagnostic findings would the nurse identify as suggestive of an acute myocardial infarction at this time?

Myoglobin

A client with an occluded coronary artery is admitted and has an emergency percutaneous transluminal coronary angioplasty (PTCA). The client is admitted to the cardiac critical care unit after the PTCA. What priority complication should the nurse monitor for?

bleeding at insertion site

During a cardiopulmonary resuscitation (CPR) class, a participant asks about the difference between cardioversion and defibrillation. What would be the instructor's best response?

• “The difference is the timing of the delivery of the electric current.”

The nurse is caring for a client experiencing an acute MI (STEMI). The nurse anticipates the health care provider will prescribe alteplase. Before administering this medication, which question is most important for the nurse to ask the client?

“What time did your chest pain start today?”

The nurse caring for a client whose sudden onset of sinus bradycardia is not responding adequately to atropine. What might be the treatment of choice for this client?

Transcutaneous pacemaker