A nurse is describing the process by which blood is ejected into circulation as the chambers of the heart become smaller. The instructor categorizes this action of the heart as what?
Systole
Diastole
Repolarization
Ejection fraction
During a shift assessment, the nurse is identifying the client's point of maximum impulse (PMI). Where will the nurse best palpate the PMI?
Left midclavicular line of the chest at the level of the nipple
Left midclavicular line of the chest at the fifth intercostal space
Midline between the xiphoid process & the left nipple
Two to three centimeters to the left of the sternum
The nurse is calculating a cardiac patient's pulse pressure. If the patient's blood pressure is 122/76 mm Hg, what is the patient's pulse pressure?
46 mm Hg
99 mm Hg
198 mm Hg
76 mm Hg
* The nurse is caring for a patient admitted with unstable angina. The laboratory result for the initial troponin I is elevated in this patient. The nurse should recognize what implication of this assessment finding?
This is only an accurate indicator of myocardial damage when it reaches its peak in 24 hours.
Because the patient has a history of unstable angina, this is a poor indicator of myocardial injury.
This is an accurate indicator of myocardial injury.
This result indicates muscle injury, but does not specify the source.
The nurse is conducting patient teaching about cholesterol levels. When discussing the patient's elevated LDL and lowered HDL levels, the patient shows an understanding of the significance of these levels by stating what?
“Increased LDL and decreased HDL increase my risk of coronary artery disease.”
"Increased LDL has the potential to decrease my risk of heart disease."
"The decreased HDL level will increase the amount of cholesterol moved away from the artery walls.”
"The increased LDL will decrease the amount of cholesterol deposited on the artery walls.”
The physician has placed a central venous pressure (CVP) monitoring line in an acutely ill patient so right ventricular function & venous blood return can be closely monitored. The results show decreased CVP. What does this indicate?
Possible hypovolemia
Possible myocardial infarction (MI)
Left-sided heart failure
Aortic valve regurgitation
* While auscultating a patient's heart sounds, the nurse hears an extra heart sound immediately after the second heart sound (S2). An audible S3 would be considered an expected finding in what patient?
An older patient
A 20-year-old
A patient who has undergone valve replacement
A patient who takes a beta-adrenergic blocker
The physical therapist notifies the nurse that the patient with coronary artery disease (CAD) experiences a much greater-than-average increase in heart rate during physical therapy. The nurse recognizes that an increase in heart rate in a patient in CAD may result in what?
Development of an atrial-septal defect
Myocardial ischemia
Formation of a pulmonary embolism
Release of potassium ions from cardiac cells
The nurse caring for a patient who as a history of heart disease. What factor should the nurse identify as possibly contributing to a decrease in cardiac output?
A change in position from standing to sitting
A heart rate of 54 beats per minute
A pulse oximetry reading of 94%
An increase in preload related to ambulation
* The nurse is caring for an 82-year-old patient. The nurse knows that changes in cardiac structure and function occur in older adults. What is a normal change expected in the aging heart of an older adult?
Decreased left ventricular ejection time
Decreased connective tissue in the SA and AV nodes and bundle branches
Thinning and flaccidity of the cardiac valves
Widening of the aorta
A resident of a long-term care facility has complained to the nurse of chest pain. What aspect of the resident’s pain would be most suggestive of angina as the cause?
The pain is worse when the resident inhales deeply.
The pain occurs immediately following physical exertion.
The pain is worse when the resident coughs.
The pain in most severe when the resident moves his upper body.
The critical care nurse is caring for a patient with a central venous pressure (CVP) monitoring system. The nurse notes that the patient's CVP is increasing. Of what may this indicate?
Psychosocial stress
Hypervolemia
Dislodgement of catheter
Hypomagnesemia
* The critical care nurse is caring for a patient with a pulmonary artery pressure monitoring system. The nurse is aware that pulmonary artery pressure monitoring is used to assess left ventricular function. What is an additional function of pulmonary artery pressure monitoring systems?
To assess the patient’s response to fluid & drug administration
To obtain specimens for arterial blood gas measurements
To dislodge pulmonary emboli
To diagnose the etiology of chronic obstructive pulmonary disease
The cardiac care nurse is reviewing the conduction system of the heart. The nurse is aware that electrical conduction of the heart usually originates in the SA node & then proceeds in what sequence?
SA node to bundle of His to AV node to Purkinje fibers
SA node to AV node to Purkinje fibers to bundle of His
SA node to bundle of His to Purkinje fibers to AV node
SA node to AV node to bundle of His to Purkinje fibers
A patient has had a myocardial infarction & has been diagnosed as having damage to the layer of the heart responsible for the pumping action. You are aware that the damage occurred where?
Endocardium
Pericardium
Myocardium
Visceral pericardium
The nurse working on a cardiac care until is caring for a patient whose stroke volume has increased. The nurse is aware that afterload influences a patient’s stroke volume. The nurse recognizes that afterload is increased when there is what?
Arterial vasoconstriction
Venous vasoconstriction
Arterial vasodilation
Venous vasodilation
* A nurse is preparing a patient for scheduled transesophageal echocardiography. What action should the nurse perform?
Instruct the patient to drink 1 liter of water before the test.
Administer IV benzodiazepines and opioids.
Inform the patient that she will remain on bed rest following the procedure.
Inform the patient that an access line will be initiated in her femoral artery.
The nurse is caring for a patient admitted with angina who is scheduled for cardiac catheterization. The patient is anxious and asks the reason for this test. What is the best response?
“Cardiac catheterization is usually done to assess how blocked or open a patients coronary arteries are.”
“Cardiac catheterization is most commonly done to detect how efficiently a patient’s heart muscle contracts.”
“Cardiac catheterization is usually done to evaluate cardiovascular response to stress.”
“Cardiac catheterization is most commonly done to evaluate cardiac electrical activity.”
The critical care nurse is caring for a patient who has had an MI. The nurse should expect to assist with establishing what hemodynamic monitoring procedure to assess the patient’s left ventricular function?
Central venous pressure (CVP) monitoring
Pulmonary artery pressure monitoring (PAPM)
Systemic arterial pressure monitoring (SAPM)
Arterial blood gases (ABG)
A critically ill patient is admitted to the ICU. The physician decides to use intra-arterial pressure monitoring. After this intervention is performed, what assessment should the nurse prioritize in the plan of care?
Fluctuations in core body temperature
Signs and symptoms of esophageal varices
Signs and symptoms of compartment syndrome
Perfusion distal to the insertion site
* The nurse is caring for an acutely ill patient who has central venous pressure monitoring in place. What intervention should be included in the care plan of a patient with CVP in place?
Apply antibiotic ointment to the insertion site twice daily.
Change the site dressing whenever it becomes visibly soiled.
Perform passive range-of-motion exercises to prevent venous stasis.
Aspirate blood from the device once daily to test pH.
A patient is brought into the ED by family members who tell the nurse the patient grabbed his chest and complained of substernal chest pain. The care team recognizes the need to monitor the patient's cardiac function closely while interventions are performed. What form of monitoring should the nurse anticipate?
Left-sided heart catheterization
Cardiac telemetry
Transesophageal echocardiography
Hardwire continuous ECG monitoring
The nurse is performing an intake assessment on a patient with a new diagnosis of coronary artery disease. What would be the most important determination to make during this intake assessment?
Whether the patient and involved family members understand the role of genetics in the etiology of the disease
Whether the patient and involved family members understand dietary changes and the role of nutrition
Whether the patient and involved family members are able to recognize symptoms of an acute cardiac problem and respond appropriately
Whether the patient and involved family members understand the importance of social support and community agencies
The nurse is relating the deficits in a patient’s synchronization of the atrial and ventricular events to his diagnosis. What are the physiologic characteristics of the nodal and Purkinje cells that provide this synchronization? Select all that apply.
Loop connectivity
Excitability
Automaticity
Conductivity
Independence
The nurse's assessment of an older adult client reveals the following data: lying BP 144/82 mm Hg; sitting BP 121/69 mm Hg; standing BP 98/56 mm Hg. The nurse should consequently identify what nursing diagnosis in the patient's plan of care?
Risk for ineffective breathing pattern related to hypotension
Risk for falls related to orthostatic hypotension
Risk for ineffective role performance related to hypotension
Risk for imbalanced fluid balance related to hemodynamic variability
* A brain (B-type) natriuretic peptide (BNP) sample has been drawn from an older adult patient who has been experienced vital fatigue and shortness of breath. This test will allow the care team to investigate the possibility of what diagnosis?
Pleurisy
Heart failure
Valve dysfunction
Cardiomyopathy
* A lipid profile has been ordered for a patient who has been experiencing cardiac symptoms. When should a lipid profile be drawn in order to maximize the accuracy of results?
As close to the end of the day as possible
After a meal high in fat
After a 12-hour fast
Thirty minutes after a normal meal
When hemodynamic monitoring is ordered for a patient, a catheter is inserted into the appropriate blood vessel or heart chamber. When assessing a patient who has such a device in place, the nurse should check which of the following components? Select all that apply.
A transducer
A flush system
A leveler
A pressure bag
An oscillator
The critical care nurse is caring for a patient who has been experiencing bradycardia after cardiovascular surgery. The nurse knows that the heart rate is determined by myocardial cells with the fastest inherent firing rate. Under normal circumstances where are these cells located?
SA node
AV node
Bundle of His
Purkinje cells
The nurse is doing discharge teaching with a patient who has coronary artery disease. The patient asks why he has to take an aspirin every day if he doesn’t have any pain. What would be the nurse’s best response?
"Taking an aspirin every day is an easy way to help restore the normal function of your heart."
"An aspirin a day can help prevent some of the blockages that can cause chest pain or heart attacks."
"Taking an aspirin every day is a simple way to make your blood penetrate your heart more freely."
"An aspirin a day eventually helps your blood carry more oxygen that it would otherwise."
The physician has ordered a high-sensitivity C-reactive protein (hs-CRP) drawn on a patient. The results of this test will allow the nurse to evaluate the role of what process that is implicated in the development of atherosclerosis?
Immunosuppression
Inflammation
Infection
Hemostasis
* The patient has a homocysteine level ordered. What aspects of this test should inform the nurse's care? Select all that apply.
A 12-hour fast is necessary before drawing the blood sample.
Recent inactivity can depress homocysteine levels.
Genetic factors can elevate homocysteine levels.
A diet low in folic acid elevates homocysteine levels.
An ECG should be performed immediately before drawing a sample.
A patient with a complex cardiac history is scheduled for transthoracic echocardiography. What should the nurse teach the patient in anticipation of this diagnostic procedure?
The test is noninvasive, and nothing will be inserted into the patient’s body.
The patient’s pain will be managed aggressively during the procedure.
The test will provide a detailed profile of the heart’s electrical activity.
The patient will remain on bed rest for 1 to 2 hours after the test.
* A critical care nurse is caring for a patient with a hemodynamic monitoring system in place. For what complications should the nurse assess? Select all that apply.
Pneumothorax
Atelectasis
Bronchospasm
Air embolism
The nurse is caring for a patient who has central venous pressure (CVP) monitoring in place. The nurse’s most recent assessment reveals that CVP is 7 mm Hg. What is the nurse’s most appropriate action?
Arrange for continuous cardiac monitoring and reposition the patient.
Remove the CVP catheter and apply an occlusive dressing.
Assess the patient for fluid overload and inform the physician.
Raise the head of the patient’s bed and have the patient perform deep breathing exercise, if possible.
* A critical care nurse is caring for a patient with a pulmonary artery catheter in place. What does this catheter measure that is particularly important in critically ill patients?
Pulmonary artery systolic pressure
Right ventricular afterload
Pulmonary artery pressure
Left ventricular preload
* A patient’s declining cardiac status has been attributed to decreased cardiac action potential. Interventions will be aimed at restoring what aspect of cardiac physiology?
The cycle of depolarization and repolarization
The time it takes from the firing of the SA node to the contraction of the ventricles
The time between the contraction of the atria and the contraction of the ventricles
The cycle of the firing of the AV node and the contraction of the myocardium
A patient has been scheduled for cardiovascular computed tomography (CT) with contrast. To prepare the patient for this test, what action should the nurse perform?
Keep the patient NPO for at least 6 hours prior to the test.
Establish peripheral IV access.
Limit the patient’s activity for 2 hours before the test.
Teach the patient to perform incentive spirometry.
The student nurse is preparing a teaching plan for a patient being discharged status post MI. What should the student include in the teaching plan? Select all that apply.
Need for careful monitoring for cardiac symptoms
Need for carefully regulated exercise
Need for dietary modifications
Need for early resumption of prediagnosis activity
Need for increased fluid intake
The nurse is caring for a patient who is undergoing an exercise stress test. Prior to reaching the target heart rate, the patient develops chest pain. What is the nurse’s most appropriate response?
Administer sublingual nitroglycerin to allow the patient to finish the test.
Initiate cardiopulmonary resuscitation.
Administer analgesia and slow the test.
Stop the test and monitor the patient closely.
