Cardiovascular Conditions - NCLEX-PN
Card 0 of 348
An EKG of your patient shows peaked T-waves. This finding correlates to which electrolyte abnormality?
An EKG of your patient shows peaked T-waves. This finding correlates to which electrolyte abnormality?
Peaked T-waves are a warning sign for elevated levels of potassium in the body. On the other hand, flattened T-waves are potentially indicative of low levels of potassium. Hyperkalemia (high potassium) is a potentially dangerous condition that can lead to cardiac abnormalities and potentially death.
Peaked T-waves are a warning sign for elevated levels of potassium in the body. On the other hand, flattened T-waves are potentially indicative of low levels of potassium. Hyperkalemia (high potassium) is a potentially dangerous condition that can lead to cardiac abnormalities and potentially death.
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Which of the following is least likely to be a co-morbidity with congestive heart failure?
Which of the following is least likely to be a co-morbidity with congestive heart failure?
Congestive heart failure tends to be precipitated by hypertension, type II diabetes, nutritional deficiencies such as thiamine, pulmonary disease, and chronic stress. Atrial fibrillation is not generally a causative factor in congestive heart failure, but these conditions are frequently seen together as they share an etiology. Vestibular irregularities are not generally observed in congestive heart failure.
Congestive heart failure tends to be precipitated by hypertension, type II diabetes, nutritional deficiencies such as thiamine, pulmonary disease, and chronic stress. Atrial fibrillation is not generally a causative factor in congestive heart failure, but these conditions are frequently seen together as they share an etiology. Vestibular irregularities are not generally observed in congestive heart failure.
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The nurse instructs the client to do which of the following to prevent dislodgment of the pacing catheter after insertion of a permanent demand pacemaker via the right subclavian vein has been made?
The nurse instructs the client to do which of the following to prevent dislodgment of the pacing catheter after insertion of a permanent demand pacemaker via the right subclavian vein has been made?
The nurse should instruct the patient to limit movement and abduction of right arm. The muscles and movement of the right arm most directly effect the placement of the pacing catheter.
The nurse should instruct the patient to limit movement and abduction of right arm. The muscles and movement of the right arm most directly effect the placement of the pacing catheter.
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A 57-year-old female presents to the clinic after newly diagnosed with stage one hypertension. The nurse is responsible for teaching this client about the condition.
The nurse should include what information in teaching this client about her medications?
A 57-year-old female presents to the clinic after newly diagnosed with stage one hypertension. The nurse is responsible for teaching this client about the condition.
The nurse should include what information in teaching this client about her medications?
Hypertension is an incurable condition, and can be controlled by various interventions. Sodium should be redced but not eliminated, and blood pressure taken by the patient should be performed once daily then weekly after blood pressure has stabilized. Patient should be encouraged to report serious side effects to the physician before stopping the medications. Optimal times to take medications are on a regular basis, not after warm baths, alcohol ingestion, or strenous exercise.
Hypertension is an incurable condition, and can be controlled by various interventions. Sodium should be redced but not eliminated, and blood pressure taken by the patient should be performed once daily then weekly after blood pressure has stabilized. Patient should be encouraged to report serious side effects to the physician before stopping the medications. Optimal times to take medications are on a regular basis, not after warm baths, alcohol ingestion, or strenous exercise.
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Which of the following results would indicate a therapeutic effect in the client taking epoetin alfa?
Which of the following results would indicate a therapeutic effect in the client taking epoetin alfa?
Epoetin alfa is used to treat anemia by causing bone marrow to produce oxygen-carrying red blood cells. Patients experiencing the therapeutic effects of the drug will have hematocrit in the range of 27-32%.
Epoetin alfa is used to treat anemia by causing bone marrow to produce oxygen-carrying red blood cells. Patients experiencing the therapeutic effects of the drug will have hematocrit in the range of 27-32%.
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The nurse recognizes the following as a client's successful response to defibrillation:
The nurse recognizes the following as a client's successful response to defibrillation:
If defibrillation is successful, the client should be arousable, have a sinus rhythm, and have BP in a normal range.
If defibrillation is successful, the client should be arousable, have a sinus rhythm, and have BP in a normal range.
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Which part of the heart is most susceptible to infective endocarditis?
Which part of the heart is most susceptible to infective endocarditis?
Because the valves of the heart don't have their own blood vessels, white blood cells can't directly get there via the bloodstream. In addition, due to the lack of vasculature, if infection does occur antimicrobial medications may have difficulty reaching the infection.
Because the valves of the heart don't have their own blood vessels, white blood cells can't directly get there via the bloodstream. In addition, due to the lack of vasculature, if infection does occur antimicrobial medications may have difficulty reaching the infection.
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A 65-year-old male client has been admitted for complications due to chronic heart failure, and is receiving several medications. Medications include digoxin, Lasix, and metoprolol. The nurse enters the client room and he informs her that he is feeling nauseous and has vomited. She suspects the client is experiencing digoxin toxicity.
What has most likely caused the client to experience digoxin toxicity?
A 65-year-old male client has been admitted for complications due to chronic heart failure, and is receiving several medications. Medications include digoxin, Lasix, and metoprolol. The nurse enters the client room and he informs her that he is feeling nauseous and has vomited. She suspects the client is experiencing digoxin toxicity.
What has most likely caused the client to experience digoxin toxicity?
Digoxin toxicity is often precipitated by low potassium levels (hypokalemia). Hypokalemia is a risk with the taking of loop diuretics such as Lasix, so monitoring of potassium levels should be performed to prevent digoxin toxicity.
Digoxin toxicity is often precipitated by low potassium levels (hypokalemia). Hypokalemia is a risk with the taking of loop diuretics such as Lasix, so monitoring of potassium levels should be performed to prevent digoxin toxicity.
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A 50-year-old male client with a history of coronary artery disease begins to complain of chest pain. The physician has placed orders in the client's chart to allow for treatment prior to being notified of the chest pains. The nurse recognizes this client is experiencing angina.
All of the following interventions by the nurse should be performed except __________.
A 50-year-old male client with a history of coronary artery disease begins to complain of chest pain. The physician has placed orders in the client's chart to allow for treatment prior to being notified of the chest pains. The nurse recognizes this client is experiencing angina.
All of the following interventions by the nurse should be performed except __________.
There is no need to place patient in high Fowler's this would probably put them at risk for orthostatic hypotension which is a common side effect of nitroglycerine treatment, as is a bounding headache. Giving oxygen, assessing blood pressure and giving nitroglycerine are all proper nursing interventions for angina.
There is no need to place patient in high Fowler's this would probably put them at risk for orthostatic hypotension which is a common side effect of nitroglycerine treatment, as is a bounding headache. Giving oxygen, assessing blood pressure and giving nitroglycerine are all proper nursing interventions for angina.
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A 54-year-old male client is being discharged from the hospital after undergoing surgery to have an implantable cardioverter-defibrillator (ICD) placed. The nurse is teaching the patient on proper guidelines for aftercare.
All of the following guidelines should be included in the teaching plan except __________.
A 54-year-old male client is being discharged from the hospital after undergoing surgery to have an implantable cardioverter-defibrillator (ICD) placed. The nurse is teaching the patient on proper guidelines for aftercare.
All of the following guidelines should be included in the teaching plan except __________.
It is important to note that an (ICD) does have the potential to set of metal detector alarms at the airport. The staff should be notified to fact to make accommodations for the patient. A hand held may be used but should not be placed directly over the implanted device.
It is important to note that an (ICD) does have the potential to set of metal detector alarms at the airport. The staff should be notified to fact to make accommodations for the patient. A hand held may be used but should not be placed directly over the implanted device.
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The nurse observes a patient undergoing a blood transfusion. Which of the following is a priority intervention by the nurse if the patient exhibits signs of a transfusion reaction?
The nurse observes a patient undergoing a blood transfusion. Which of the following is a priority intervention by the nurse if the patient exhibits signs of a transfusion reaction?
The priority consideration for a nurse when a patient exhibits signs of a transfusion reaction include focus on the airway. Anaphylactic and hemolytic reactions diminish the ability of circulating blood to be oxygenated. The priority is to maintain a patent airway so circulating blood may remain oxygenated. After assessing the patient’s airway, the nurse should administer supplemental oxygen, stop the blood, give Benadryl (if it is an allergic reaction), and then notify the physician.
The priority consideration for a nurse when a patient exhibits signs of a transfusion reaction include focus on the airway. Anaphylactic and hemolytic reactions diminish the ability of circulating blood to be oxygenated. The priority is to maintain a patent airway so circulating blood may remain oxygenated. After assessing the patient’s airway, the nurse should administer supplemental oxygen, stop the blood, give Benadryl (if it is an allergic reaction), and then notify the physician.
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A client with newly diagnosed heart failure after myocardial infarction calls the clinic to ask about his new medications. Which of the following statements made by the patient concerns the triage nurse?
A client with newly diagnosed heart failure after myocardial infarction calls the clinic to ask about his new medications. Which of the following statements made by the patient concerns the triage nurse?
Patients with heart failure after myocardial infarction often take many new medications. It is important to adequately educate these patients on each of the side effects and dosing schedules of each medication. Digoxin is a fundamental drug in the treatment of heart failure. The maintenance dose of digoxin is essential to maintain optimal cardiac functioning and should not be missed. Digoxin may induce nausea and vomiting, and this should be communicated to the primary care provider so it may be treated. Among other essential heart failure medications are vasodilators and inotropic agents, as well as antihypertensive medications such as diuretics, beta-blockers, and ACE inhibitors. Diuretics such as hydrochlorothiazide should be taken in the morning because they induce diuresis - this would disrupt sleeping if taken later in the day or at bedtime. Vasodilators such as nitroglycerin are essential to decrease afterload in the case of angina. Beta-blockers such as metoprolol are most effective when taken without food, such as before breakfast or at bedtime. Antihypertensive medications may also cause orthostatic hypotension, so it is essential for patients to change positions slowly.
Patients with heart failure after myocardial infarction often take many new medications. It is important to adequately educate these patients on each of the side effects and dosing schedules of each medication. Digoxin is a fundamental drug in the treatment of heart failure. The maintenance dose of digoxin is essential to maintain optimal cardiac functioning and should not be missed. Digoxin may induce nausea and vomiting, and this should be communicated to the primary care provider so it may be treated. Among other essential heart failure medications are vasodilators and inotropic agents, as well as antihypertensive medications such as diuretics, beta-blockers, and ACE inhibitors. Diuretics such as hydrochlorothiazide should be taken in the morning because they induce diuresis - this would disrupt sleeping if taken later in the day or at bedtime. Vasodilators such as nitroglycerin are essential to decrease afterload in the case of angina. Beta-blockers such as metoprolol are most effective when taken without food, such as before breakfast or at bedtime. Antihypertensive medications may also cause orthostatic hypotension, so it is essential for patients to change positions slowly.
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The nurse cares for a patient in the stroke unit. The physician has ordered thrombolytic therapy for this patient. The nurse knows that the patient cannot receive thrombolytic medication if which of these is true?
The nurse cares for a patient in the stroke unit. The physician has ordered thrombolytic therapy for this patient. The nurse knows that the patient cannot receive thrombolytic medication if which of these is true?
Thrombolytic therapy is commonly given to patients who have strokes to dissolve clots. This therapy is contraindicated in people who have recently had surgery due to the risk for hemorrhage. It is also contraindicated in currently pregnant women. Ibuprofen and beta blockers are not contraindications to thrombolytic therapy. Cardiac dysrhythmias are also not contraindicated with thrombolytic therapy.
Thrombolytic therapy is commonly given to patients who have strokes to dissolve clots. This therapy is contraindicated in people who have recently had surgery due to the risk for hemorrhage. It is also contraindicated in currently pregnant women. Ibuprofen and beta blockers are not contraindications to thrombolytic therapy. Cardiac dysrhythmias are also not contraindicated with thrombolytic therapy.
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The home health nurse cares for a 6-month-old infant with heart failure. The child is receiving diuretic therapy at home. Which of the following symptoms manifested in the child may indicate a need for further intervention?
The home health nurse cares for a 6-month-old infant with heart failure. The child is receiving diuretic therapy at home. Which of the following symptoms manifested in the child may indicate a need for further intervention?
Weight gain is an early symptom of worsened congestive heart failure due to an accumulation of fluid in the vascular system that has not been diuresed. With fluid overload, the nurse should expect to see an increase in blood pressure, as well as tachypnea and tachycardia. Fluid overload may indicate a need for increased diuresis. Infants and children with congestive heart failure commonly demonstrate decreased appetites, so increased hunger would not be a negative sign.
Weight gain is an early symptom of worsened congestive heart failure due to an accumulation of fluid in the vascular system that has not been diuresed. With fluid overload, the nurse should expect to see an increase in blood pressure, as well as tachypnea and tachycardia. Fluid overload may indicate a need for increased diuresis. Infants and children with congestive heart failure commonly demonstrate decreased appetites, so increased hunger would not be a negative sign.
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Which hypertension drug is known to cause side effects such as, bradycardia, first degree heart block, and gingival hyperplasia?
Which hypertension drug is known to cause side effects such as, bradycardia, first degree heart block, and gingival hyperplasia?
Calcium channel blockers, such as amlodipine cause side effects that affect the conduction of the heart. Other side effects include nausea, headache, rash, and gingival hyperplasia.
Calcium channel blockers, such as amlodipine cause side effects that affect the conduction of the heart. Other side effects include nausea, headache, rash, and gingival hyperplasia.
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An EKG monitor reveals a patient is in ventricular fibrillation. He is subsequently provided the appropriate management and is converted to normal sinus rhythm. What is the mechanism of this management?
An EKG monitor reveals a patient is in ventricular fibrillation. He is subsequently provided the appropriate management and is converted to normal sinus rhythm. What is the mechanism of this management?
Ventricular fibrillation is a potentially lethal rhythm. It is treated via defibrillation. This is an electrical shock that temporarily stops the heart in an attempt to have the natural pacemaker rhythm of the heart take over. Electrical therapy via defibrillation is the appropriate management of ventricular fibrillation.
Ventricular fibrillation is a potentially lethal rhythm. It is treated via defibrillation. This is an electrical shock that temporarily stops the heart in an attempt to have the natural pacemaker rhythm of the heart take over. Electrical therapy via defibrillation is the appropriate management of ventricular fibrillation.
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A client has just undergone an electrocardiogram (ECG), the nurse notes that the QRS complex is measured to be 0.09 seconds. What is the first action the nurse should take?
A client has just undergone an electrocardiogram (ECG), the nurse notes that the QRS complex is measured to be 0.09 seconds. What is the first action the nurse should take?
This is a normal finding, the QRS should have a duration between 0.6-0.12 seconds.
This is a normal finding, the QRS should have a duration between 0.6-0.12 seconds.
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You are taking care of an elderly patient who is hospitalized for sudden onset of severe, diffuse abdominal pain out of proportion to the patient's abdominal physical exam that is also accompanied by rectal bleeding and palpitations. You obtain an ECG and notice a tachycardic, irregularly irregular rhythm without any distinct P waves. Which of the following is the most likely cardiac rhythm seen on this patient's ECG?
You are taking care of an elderly patient who is hospitalized for sudden onset of severe, diffuse abdominal pain out of proportion to the patient's abdominal physical exam that is also accompanied by rectal bleeding and palpitations. You obtain an ECG and notice a tachycardic, irregularly irregular rhythm without any distinct P waves. Which of the following is the most likely cardiac rhythm seen on this patient's ECG?
The most likely cardiac rhythm on this patient's ECG is a trial fibrillation.
Atrial fibrillation is a tachyarrhythmia that is characterized on ECG by absence of distinct P waves, oscillating "f" waves that cause an irregular baseline rhythm, and abnormal, inconsistent R-R intervals that produce an irregularly irregular rhythm.
When a patient is in atrial fibrillation, the patient may be asymptomatic, but at other times, the patient may complain of a rapid heartbeat, or a feeling of uneasiness. The clues in this case that the patient is in atrial fibrillation are that the ECG shows the characteristic irregularly irregular rhythm, with an absence of any distinct P waves.
Clinically, the other clues are that the patient is complaining of palpitations while simultaneously experiencing sudden onset of severe, diffuse abdominal pain that is out of proportion to the abdominal physical exam, and is accompanied by rectal bleeding. This is very consistent with mesenteric ischemia (a condition in which a patient, typically in atrial fibrillation, projects a blood clot to one of the mesenteric vessels, causing ischemia to the bowel served by the affected vessel). While, this was not asked in the question explicitly, and the question could be answered without this knowledge, this helps confirm the diagnosis if you are aware of it.
The other answers are incorrect for the following reasons:
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Atrial flutter typically presents with a "sawtooth" waveform and has more regularity in wavelength.
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Sick sinus syndrome is also known as tachy-brady syndrome, indicating that the patient has frequent fluctuations between tachycardia and bradycardia. In this instance, we have ECG findings that are very consistent with atrial fibrillation and show no evidence of bradycardia.
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First-degree heart block and complete heart block are each typically characterized by bradycardia rather than tachycardia, and do not appear like atrial fibrillation on ECG.
The most likely cardiac rhythm on this patient's ECG is a trial fibrillation.
Atrial fibrillation is a tachyarrhythmia that is characterized on ECG by absence of distinct P waves, oscillating "f" waves that cause an irregular baseline rhythm, and abnormal, inconsistent R-R intervals that produce an irregularly irregular rhythm.
When a patient is in atrial fibrillation, the patient may be asymptomatic, but at other times, the patient may complain of a rapid heartbeat, or a feeling of uneasiness. The clues in this case that the patient is in atrial fibrillation are that the ECG shows the characteristic irregularly irregular rhythm, with an absence of any distinct P waves.
Clinically, the other clues are that the patient is complaining of palpitations while simultaneously experiencing sudden onset of severe, diffuse abdominal pain that is out of proportion to the abdominal physical exam, and is accompanied by rectal bleeding. This is very consistent with mesenteric ischemia (a condition in which a patient, typically in atrial fibrillation, projects a blood clot to one of the mesenteric vessels, causing ischemia to the bowel served by the affected vessel). While, this was not asked in the question explicitly, and the question could be answered without this knowledge, this helps confirm the diagnosis if you are aware of it.
The other answers are incorrect for the following reasons:
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Atrial flutter typically presents with a "sawtooth" waveform and has more regularity in wavelength.
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Sick sinus syndrome is also known as tachy-brady syndrome, indicating that the patient has frequent fluctuations between tachycardia and bradycardia. In this instance, we have ECG findings that are very consistent with atrial fibrillation and show no evidence of bradycardia.
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First-degree heart block and complete heart block are each typically characterized by bradycardia rather than tachycardia, and do not appear like atrial fibrillation on ECG.
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A patient presents with thirty minute history of substernal chest pain that radiates to his left jaw. Which of the following EKG changes would you expect in this patient if his troponin level came back positive at 
?
A patient presents with thirty minute history of substernal chest pain that radiates to his left jaw. Which of the following EKG changes would you expect in this patient if his troponin level came back positive at
Substernal chest pain that radiates to the jaw is classic of myocardial infarction. Elevated troponin and EKG changes help confirm the diagnosis (reference levels are about 
. ST segment elevation is classically seen in myocardial infarctions that result in positive troponin.
Substernal chest pain that radiates to the jaw is classic of myocardial infarction. Elevated troponin and EKG changes help confirm the diagnosis (reference levels are about
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You are a nurse taking care of a patient in the emergency room. Among other acute labwork and imaging, you obtain an electrocardiogram (ECG) of the patient. The ECG shows Osborn waves. Which of the following is the most common cause of Osborn waves on ECG?
You are a nurse taking care of a patient in the emergency room. Among other acute labwork and imaging, you obtain an electrocardiogram (ECG) of the patient. The ECG shows Osborn waves. Which of the following is the most common cause of Osborn waves on ECG?
The correct answer is "hypothermia." Osborn waves on electrocardiogram are the pathognomonic finding associated with hypothermia (to a core body temperature of lower than 32 C). Osborn waves are observed as upward deflections in the ECG reading between the QRS and ST intervals with an elevation at the S point (which is sometimes also referred to as the J point). While hypothermia is the most common cause of Osborn waves, they may also be observed in patients with coronary vasospasm, hypercalcemia, ventricular fibrillation, or brain trauma.
Neither hyperthermia, ethanol toxicity, carbon monoxide poisoning, nor lead poisoning are associated with Osborn waves on ECG.
The correct answer is "hypothermia." Osborn waves on electrocardiogram are the pathognomonic finding associated with hypothermia (to a core body temperature of lower than 32 C). Osborn waves are observed as upward deflections in the ECG reading between the QRS and ST intervals with an elevation at the S point (which is sometimes also referred to as the J point). While hypothermia is the most common cause of Osborn waves, they may also be observed in patients with coronary vasospasm, hypercalcemia, ventricular fibrillation, or brain trauma.
Neither hyperthermia, ethanol toxicity, carbon monoxide poisoning, nor lead poisoning are associated with Osborn waves on ECG.
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