Cardiovascular NCLEX

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aspirin
A client has been diagnosed with atrial fibrillation. The health care
provider prescribed warfarin to be taken on a daily basis. The
Aspirin is an antiplatelet medication. The use of aspirin is con-
nurse instructs the client to avoid using which over-the-counter
traindicated while taking warfarin because it will potentiate the
medication while taking warfarin?
drug's effects.
confusion, urine output 15 mL over the last 2 hours, orthopnea
The nurse has completed an assessment on a client with a de-
creased cardiac output. Which findings should receive the highest
A low urine output and confusion are signs of decreased tissue
priority?
perfusion. Orthopnea is a sign of left-sided heart failure.
The client will receive medication to relieve pain.

In preparing the client and the family for a postoperative stay in the Management of postoperative pain is a priority for the client after
intensive care unit (ICU) after open-heart surgery, what should the surgery, including valve replacement surgery. The client and family
nurse tell the family? should be informed that pain will be assessed by the nurse and
medications will be given to relieve the pain. The client will stay in
the ICU as long as monitoring and intensive care are needed.
heart failure
The nurse is assigned to a client in the ICU. During the initial as-
sessment, the nurse notes jugular vein distention and recognizes
Elevated venous pressure, exhibited as jugular vein distention,
that the plan of care will follow which disorder?
indicates the heart's failure to pump.
creatinine level and liver function tests
The nurse is preparing the client newly diagnosed with peripheral
arterial disease for discharge with the medication atorvastatin. Atorvastatin has serious adverse reactions of hepatotoxicity and
What laboratory work should the nurse obtain to establish a base- acute renal failure, so it is recommended that creatinine level
line before starting the medication? and liver function tests be performed at baseline as a monitoring
parameter.
An anxious client who suffered an acute myocardial infarction is
transferred from the coronary care unit to the telemetry unit. The
"We will try to assign you the same nurse as often as possible."
client asks the charge nurse if they can have the same nurse care
for them every day. How should the charge nurse respond?
A client who has a history of bacterial endocarditis is scheduled
Be sure the dentist prescribes a prophylactic antibiotic prior to the
to have oral surgery to remove a tooth. What should the nurse
oral surgery.
instruct the client to do?
A nurse is caring for a client who had a three-vessel coronary
bypass graft 4 days earlier. The client's cholesterol profile is as
follows: total cholesterol 265 mg/dl (6.845 mmol/L), low-density
the nurse will ask the dietitian to talk with the client about modifying
lipoprotein (LDL) 139 mg/dl (3.603 mmol/L), and high-density
their diet.
lipoprotein (HDL) 32 mg/dl (0.829 mmol/L). The client asks the
nurse how to lower their cholesterol. The nurse should tell the
client that
assess the client for bleeding around the gums or in the stool
and notify the physician of the laboratory results and most recent
administration of warfarin.
A nurse is caring for a client receiving warfarin therapy following a
mechanical valve replacement. The nurse completed the client's
For a client taking warfarin following a valve replacement, the
prothrombin time and International Normalized Ratio (INR) at 7
INR should be between 2 and 3.5. The nurse should notify the
a.m. (0700), before the morning meal. The client had an INR
physician of an elevated INR level and communicate assessment
reading of 4. The nurse's first priority should be to
data regarding possible bleeding. The nurse shouldn't administer
medication such as warfarin or vitamin K without a physician's
order.
Avoid eating foods high in potassium.

=Spironolactone is a potassium-sparing diuretic that causes ex-

A client is taking spironolactone. Which change in the diet should cretion of sodium. When taking this drug, it is important that the
the nurse teach the client to make when taking this drug? client not eat foods high in potassium to avoid elevating serum
potassium levels.
=The client does not need to restrict sodium intake as the drug
promotes sodium excretion.

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A visiting nurse is teaching a client with heart failure about taking
their medications. The client requires six different medications that
Teach a family member to fill a medication compliance aid once
are taken at four different times per day. The client is confused
per week so the client can independently take their medications.
about when to take each medication. How should the nurse inter-
vene?
The correct landmark for obtaining an apical pulse is the left fifth intercostal space, midclavicular line.
rheumatic fever
A nurse is obtaining a history from a new client in the cardiovascu-
lar clinic. When investigating for childhood diseases and disorders
Childhood diseases and disorders associated with structural heart
associated with structural heart disease, which finding should the
disease include rheumatic fever and severe streptococcal (not
nurse consider significant?
staphylococcal) infections.
electrocardiogram (ECG) results.
A client is taking spironolactone to control hypertension. The
client's serum potassium level is [6 mEq/L (56mmol/L)]. For this Although changes in all these findings are seen in hyperkalemia,
client, the nurse's priority should be to assess their ECG results should take priority because changes can indicate
potentially lethal arrhythmias such as ventricular fibrillation.
troponin level.
A client with severe angina pectoris and ST-segment elevation on
an electrocardiogram is being seen in the emergency department. Troponin is a myocardial cell protein that is elevated in the serum
In terms of diagnostic laboratory testing, it's most important for the when myocardial damage has occurred during a myocardial in-
nurse to advocate ordering a: farction (MI). It's the best serum indicator of MI and is more
indicative of cardiac damage than creatine kinase.
The client asks the nurse, "Why won't the health care provider tell
me exactly how much of my leg he is going to take off? Don't you
the adequacy of the blood supply to the tissues
think I should know that?" On which information should the nurse
base the response?
Revascularize the blocked coronary artery.
The nurse is evaluating a client who received tissue plasminogen
activator (t-PA) following a myocardial infarction (MI). What is the The thrombolytic agent t-PA, administered intravenously, lyses the
expected outcome of this drug? clot blocking the coronary artery. The drug is most effective when
administered within the first 6 hours after the onset of MI.
within 6 hours
A client with chest pain doesn't respond to nitroglycerin. When the
client is admitted to the emergency department, the healthcare For the best chance of salvaging the client's myocardium, a throm-
team obtains an electrocardiogram and administers I.V. mor- bolytic agent must be administered within 6 hours after onset of
phine. The physician also considers administering alteplase. This chest pain or other signs or symptoms of MI. Sudden death is
thrombolytic agent must be administered how soon after onset of most likely to occur within the first 24 hours after an MI. Physicians
myocardial infarction (MI) symptoms? initiate I.V. heparin therapy after administration of a thrombolytic
agent; it usually continues for 5 to 7 days.
Which condition most commonly results in coronary artery dis-
atherosclerosis
ease (CAD)?
Three days after surgery to insert a mechanical mitral valve, the
client asks what can be done to muffle the clicking sound since
it is embarrassing and others will know an artificial valve is in the anxiety related to altered body image
heart. The nurse's response should reflect the understanding that
the client may be experiencing which concern?
Decreased cardiac output related to depressed myocardial func-
tion.
A client is recovering from coronary artery bypass graft (CABG)
surgery and begins to experience chest pain, shortness of breath,
For a client recovering from CABG surgery and experiencing
and tachycardia. Further assessment reveals a widened QRS
these symptoms, decreased cardiac output is the most important
complex and an elevated ST segment. Which nursing diagnosis
nursing diagnosis. Complications of CABG include hemorrhage,
takes highest priority at this time?
dysrhythmias, and myocardial infarction (MI) leading to decreased
cardiac output
"I'll keep a log of each time my ICD discharges."

This log helps the client and physician identify activities that may
cause the arrhythmias that make the ICD discharge. The client
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should also record the events right before the discharge. Clients
A nurse is performing discharge teaching with a client who has
with ICDs should avoid contact sports such as football. They must
an implantable cardioverter defibrillator (ICD) placed. Which client
also avoid magnetic fields, which could permanently damage the
statement indicates effective teaching?
ICD. Household appliances don't interfere with the ICD.
instructing the client to notify the health care provider of irregular
or slowed pulse rate.

--Propranolol hydrochloride is a ?-adrenergic blocking agent used

to treat hypertension. In addition to lowering blood pressure by
The plan of care for a client with hypertension taking propranolol
blocking sympathetic nervous system stimulation, the drug lowers
hydrochloride should include:
the heart rate. Therefore, the client should be assessed for brady-
cardia and other arrhythmias.
--The client needs to be instructed not to discontinue medica-
tion because sudden withdrawal of propranolol hydrochloride may
cause rebound hypertension.
A client is about to undergo cardiac catheterization for which
informed consent was obtained. As the nurse enters the room
to administer sedation for the procedure, the client states, "I'm Withhold the medication and notify the physician immediately.
really worried about having this open heart surgery." Based on
this statement, how should the nurse proceed?
infection.
A client with neutropenia has an absolute neutrophil count (ANC)
of 900 (0.9 × 109/L). The nurse teaches the client to prevent which
A client is at moderate risk for infection when the ANC is <1,000
risk of neutropenia?
(1 × 109/L).
Which statement would lead the nurse to determine that a client
"I already have my airline ticket, so I won't miss my meeting
lacks understanding of the client's acute cardiac illness and the
tomorrow."
ability to make lifestyle changes?
hyperkalemia.

The client has been prescribed lisinopril to treat hypertension. The Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor.
nurse should assess the client for which electrolyte imbalance? Hyperkalemia can be a side effect of ACE inhibitors. Because of
this side effect, ACE inhibitors should not be administered with
potassium-sparing diuretics.
The monitor technician informs the nurse that the client has start-
ed having premature ventricular contractions every other beat. Assess the client's orientation and vital signs.
What should the nurse do first?
"This drug will dilate your blood vessels and lower your blood
pressure."

The client with heart failure asks the nurse about the reason for Enalapril maleate is an angiotensin-converting enzyme inhibitor
taking enalapril maleate. The nurse should tell the client: that prevents conversion of angiotensin I to angiotensin II. An-
giotensin II is a potent vasoconstrictor and also contributes to
aldosterone secretion. Thus, enalapril decreases blood pressure
through systemic vasodilation.
Report to the health care provider that the pacemaker is failing to
capture.
The nurse is observing the electrocardiogram (EKG) rhythm of a
client with a permanent pacemaker and determines there is not a Failure to capture is observed when the pacemaker fails to gen-
QRS complex that follows the pacemaker spike. Which follow-up erate a complex; in this case, the pacemaker fails to generate
action is most appropriate? a ventricular complex with the QRS. This needs to be reported
to the health care provider and the client should be assessed to
determine any clinical manifestations of low blood flow due to this.
When the nurse is assessing an individual with peripheral artery
disease, which clinical manifestation would indicate complete ar- coldness of the left foot and ankle
terial obstruction in the lower left leg?
The client has had hypertension for 20 years. The nurse should
Renal insufficiency and failure.
assess the client for?

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The nurse has given a client a nitroglycerin tablet sublingually for
angina. Which vital signs should be assessed following adminis- blood pressure
tration of nitroglycerin?
The nurse is admitting an older adult to the hospital. The echocar-
diogram report revealed left ventricular enlargement. The nurse
Assess respiratory status.
notes 2+ pitting edema in the ankles when getting the client into
bed. Based on this finding, what should the nurse do first?
electrocardiogram (ECG).
Following a myocardial infarction, a client develops an arrhythmia
and requires a continuous infusion of lidocaine. To monitor the Lidocaine is an antiarrhythmic and is given for the treatment of
effectiveness of the intervention, the nurse should focus primarily cardiac irritability and ventricular arrhythmias. The best indicator of
on the client's: its effectiveness is a reduction in or disappearance of ventricular
arrhythmias as seen on an ECG.
Which food should the nurse teach a client with heart failure to
canned tomato juice
limit when following a 2-gram sodium diet?
A nurse is teaching a client who receives nitrates for the relief of
Lie down or sit in a chair for 5 to 10 minutes after taking the drug.
chest pain. Which instruction should the nurse emphasize?
During physical assessment, the nurse should further assess the
client for signs of atrial fibrillation when the nurse palpates the irregular rhythm with pulse rate greater than 100 bpm
radial pulse and notices which signs?
Following diagnosis of angina pectoris, a client reports being
unable to walk up two flights of stairs without pain. What should Take a nitroglycerin tablet before climbing the stairs.
the nurse instruct the client to do?
The nurse is assessing a client who is at risk for cardiac tampon-
ade from chest trauma sustained in a motorcycle accident. What
26
is the client's pulse pressure if the blood pressure is 108/82 mm
Hg? Record your answer using a whole number.
During surgery, a client develops sinus bradycardia. The physician
orders atropine sulfate. Which dose and route should the nurse 1 mg I.V.
use?
A nurse is caring for a client with end-stage heart failure who is
awaiting a heart transplant. The client tells the nurse that they think
Contact the clergy member who is assigned to the transplant
they are going to die before a donor heart is found. The client also
team.
tells the nurse that they have not been attending a church but
wants to talk with a priest. What action should the nurse take?
A client with a history of coronary artery disease (CAD) has
been diagnosed with peripheral arterial disease. The health care
provider (HCP) started the client on pentoxifylline once daily. Ap- Inform the HCP.
proximately 1 hour after receiving the initial dose of pentoxifylline,
the client reports having chest pain. The nurse should first:
After receiving the shift report, a registered nurse in the cardiac
step-down unit must prioritize the client care assignment. The
nurse has an ancillary staff member available to help care for the the client with heart failure who is having some difficulty breathing
clients. Which of these clients should the registered nurse assess
first?
The nurse is obtaining the pulse of a client who has had a
femoral-popliteal bypass surgery 6 hours ago. Which assessment
Pedal Pulse, dorsal foot
provides the most accurate information about the client's postop-
erative status?
electrocardiogram (ECG) electrodes
The rapid response team arrives in the room of a client who has
had a cardiac arrest. The nurse should first apply which piece of apply the ECG electrodes to the client's chest. If the client is
monitoring equipment? found to be in ventricular fibrillation, the immediate priority is to
defibrillate the client.
A nurse is caring for a client with acute pulmonary edema. To
immediately promote oxygenation and relieve dyspnea, the nurse place the client in high Fowler's position.
should
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While caring for a client who has sustained a myocardial infarction
(MI), the nurse notes eight premature ventricular contractions
(PVCs) in 1 minute on the cardiac monitor. The client is receiving Notify the health care provider (HCP).
an IV infusion of 5% dextrose in water (D5W) at 125 mL/h and
oxygen at 2 L/min. What should the nurse do first?
What measure should the nurse take that will be most helpful in
preventing wound infection when changing a client's dressing after Wash hands before changing the dressing.
coronary artery bypass surgery?
A client with aortic stenosis tells the nurse, "I have been feeling
so tired lately that I take a nap in my recliner every afternoon." On
assessment, the nurse notes apical heart sounds 2 cm left of the
weight gain of 2.5 kg (5.5 lb) in 24 hours
midclavicular line, crackles in lower lung fields during respiration,
blood pressure 110/90 mm Hg, and weight gain of 2.5 kg (5.5 lb)
in 24 hours. Which assessment requires further action?
Before discharge from the hospital after a myocardial infarction, a
client is taught to exercise by gradually increasing the distance
walked. Which vital sign should the nurse teach the client to Pulse
monitor to determine whether to increase or decrease the exercise
level?
a 29-year-old male with a 14-year history of cigarette smoking.

Thromboangiitis obliterans (Buerger's disease) is a nonathero-

Which client is at greatest risk for Buerger's disease?
sclerotic, inflammatory vaso-occlusive disorder. The disorder oc-
curs predominantly in younger men less than 40 years of age, and
there is a very strong relationship with tobacco use.
encourage the client to avoid standing in one position for long
periods of time.
The nurse observes that an older female has small to moderate,
distended and tortuous veins running along the inner aspect of The client has varicose veins, which are evident by the tortuous,
her lower legs. The nurse should: distended veins where blood has pooled. To prevent pooling of the
blood, the client should not stand in one place for long periods of
time.
A client with second-degree atrioventricular heart block is ad-
mitted to the coronary care unit. The nurse closely monitors the
client's heart rate and rhythm. When interpreting the client's elec- ventricular depolarization.
trocardiogram (ECG) strip, the nurse knows that the QRS complex
represents
Following cardiac bypass surgery, the client has been referred to
a cardiac rehabilitation exercise program. The client has type 1
diabetes and has bilateral leg discomfort with walking. The client
diabetic neuropathy
is exercising using a stationary bicycle. The nurse should evaluate
the client's response to exercise by assessing the presence of
which condition?
A client with deep vein thrombosis has been receiving warfarin Return to laboratory for analysis of prothrombin times.
for 2 months. The client is to go to an anticoagulant monitoring
laboratory every 3 weeks. The last visit to the laboratory was 2 These symptoms suggest that the client is receiving too much
weeks ago. The client reports bleeding gums, increased bruising, warfarin; the client should return to the laboratory and have a blood
and dark stools. What should the nurse should instruct the client sample drawn to determine the prothrombin levels and have the
to do? dosage of warfarin adjusted
The nurse's unit council in the telemetry unit is responsible for
performance improvement studies. What information should they the percentage of clients on the unit diagnosed with an acute MI
gather to study whether client education about resuming sexual who were taught about resuming sexual activity
activity after an acute myocardial infarction (MI) is being taught?
"Limiting my salt intake to 2 grams per day will lower my blood
The nurse evaluates the client's understanding of nutritional mod- pressure."
ifications to manage hypertension. The nurse knows the teaching
was successful when the client makes what statement? To lower blood pressure, a client should limit daily salt intake to
2 g or less. Alcohol intake is associated with a higher incidence
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of hypertension, poor compliance with treatment, and refractory
hypertension. Chronic, moderate caffeine intake and fat intake do
not affect blood pressure.
When a client has a troponin level of 0.9 ng/mL, which nursing
Notify the healthcare provider.
intervention should be implemented?
After extensive cardiac bypass surgery, a client returns to the
intensive care unit on dobutamine, 5 mcg/kg/minute I.V. Which Direct-acting beta-active agent
classification best describes dobutamine?
A client has a coxsackie B (viral) or trypanosomal (parasite) infec-
tion. The nurse should further assess the client for which health myocarditis
problem?
"Notify your healthcare provider if you experiences visual
changes."

A newly admitted client reports taking digoxin and warfarin. Which Hypokalemia can exacerbate digoxin toxicity so potassium should
statement would the nurse include in the discharge instructions? not be limited. The client will be taught the signs and symptoms of
digoxin toxicity and what needs to be reported to the healthcare
provider. Visual changes and anorexia are signs of digoxin toxicity
and should be reported.
The nurse is assessing a client who had an abdominal aortic
aneurysm repair 2 hours ago. Which finding warrants further eval- an arterial blood pressure of 80/50 mm Hg
uation?
A client weighs 300 lb (136 kg) and has a history of deep vein
thrombosis and thrombophlebitis. When coaching a client about
"I'll try to lose weight by following a reduced-calorie, balanced
behaviors to maintain health, the nurse determines that the client
diet."
has understood the nurse's instructions when the client makes
which statement?
left end-diastolic pressure.

When wedged, the catheter is "pointing" indirectly at the left

A client has had a pulmonary artery catheter inserted. In per-
end-diastolic pressure. The pulmonary artery wedge pressure is
forming hemodynamic monitoring with the catheter, the nurse will
measured when the tip of the catheter is slowing inflated and
wedge the catheter to gain information about:
allowed to wedge into a branch of the pulmonary artery. Once the
balloon is wedged, the catheter reads the pressure in front of the
balloon.
a short period of asystole

The expected response to this medication is a short period of

The nurse is administering *adenosine* to a client with supraven-
asystole, bradycardia, hypotension, dyspnea, and chest pain fol-
tricular tachycardia. What is the expected therapeutic response?
lowed by a return to normal sinus rhythm. It is used to convert
dysrhythmias to normal sinus rhythm and should not cause ven-
tricular tachycardia
vasodilation of peripheral vasculature.
As an initial step in treating a client with angina, the health care
provider (HCP) prescribes *nitroglycerin* tablets, 0.3 mg given
Nitroglycerin produces peripheral vasodilation, which reduces
sublingually. This drug's principal effects are produced by:
myocardial oxygen consumption and demand.
pepperoni pizza
The nurse advises a client recovering from a myocardial infarction
bacon
to decrease fat and sodium intake. Which foods should the nurse
cheese
instruct the client to avoid? Select all that apply.
soft drinks
A client arrives in the emergency department reporting intense
pain in the abdomen and tells the nurse that it feels like a heart-
The client reports increasing severe back pain.
beat in the abdomen. Which nursing assessment would indicate
potential *rupture of an aortic aneurysm*?

pericardial tamponade
A nurse in the telemetry unit is caring for a client with diagnosis of
postoperative coronary artery bypass graft (CABG) surgery from
A paradoxical pulse (a palpable decrease in pulse amplitude on

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2 days ago. On assessment, the nurse notes a paradoxical pulse quiet inspiration) signals pericardial tamponade, a complication of
of 88. Which surgical complication would the nurse suspect? CABG surgery.
The nurse is assessing a 48-year-old client with a history of smok- ankle brachial index of 0.65
ing during a routine clinic visit. The client, who exercises regularly,
reports having pain in the calf during exercise that disappears at >0.9 suggests moderate arterial vascular disease in a client who
rest. Which finding requires further evaluation? is experiencing intermittent claudication
When teaching a client with newly diagnosed hypertension about
the pathophysiology of this disease, the nurse states that arterial
baroreceptors, which monitor arterial pressure, are located in the aorta
carotid sinus. Which other area should the nurse mention as a site
of arterial baroreceptors?
banana
A client receiving a loop diuretic should be encouraged to eat
dried fruit
which foods to prevent potassium loss? Select all that apply.
orange juice
Bed rest with the affected extremity elevated.
A client is diagnosed with thrombophlebitis. What nursing action
Elevation of the affected leg facilitates blood flow by the force of
would demonstrate the appropriate level of activity for this client?
gravity and also decreases venous pressure, which in turn relieves
edema and pain.
"I'll carefully massage the ointment into the skin."

The client should not rub or massage the ointment into the skin.
The ointment should be allowed to absorb slowly.
The nurse is teaching a client how to apply nitroglycerin topical
ointment. Which statement indicates that the client needs addi- -The client should use the applicator paper to measure the amount
tional clarification of the instructions? of ointment to apply.
-The client should rotate the application sites to avoid skin irrita-
tion.
-The client should remove any remaining ointment with a tissue
before applying a new dose.
history of aortic valve replacement.
A white male, age 43, with a tentative diagnosis of infective en-
docarditis is admitted to an acute care facility. His medical history
A heart valve prosthesis such as an aortic valve replacement is a
reveals diabetes mellitus, hypertension, and pernicious anemia;
major risk factor for infective endocarditis. Other risk factors in-
he underwent an appendectomy 20 years earlier and an aortic
clude a history of heart disease (especially mitral valve prolapse),
valve replacement 2 years before this admission. Which history
chronic debilitating disease, I.V. drug abuse, and immunosuppres-
finding is a major risk factor for infective endocarditis?
sion.
red, warm, palpable linear cord along the vein that is painful on
palpation

-Superficial thrombophlebitis is associated with pain, warmth, and

The nurse is assessing a client with superficial thrombophlebitis in
erythema. The nurse can request a prescription for warm packs to
the greater saphenous vein of the left leg. The client has "aching"
relieve the pain.
in the leg. Which finding indicates the nurse should contact the
-Venous insufficiency causes edema and a brown discoloration of
health care provider (HCP) to request a prescription to improve
the lower leg.
the client's comfort?
-Varicose veins are dark, protruding veins, and symptoms of dis-
comfort increase with standing.
-Pain on dorsiflexion of the foot indicates deep vein thrombosis
(DVT); the client does not indicate having this pain.
A client is admitted to the emergency department with a history
of abdominal aortic aneurysm. The nurse assesses the client for
increased abdominal and back pain
which sign or symptom that suggests the client's abdominal aortic
aneurysm is extending?
An older adult is admitted to the hospital with nausea and vomiting.
The client has a history of heart failure and is being treated with
digoxin. The client has been nauseated for a week and began
digoxin toxicity.
vomiting 2 days ago. Laboratory values indicate hypokalemia.
Because of these clinical findings, the nurse should assess the
client carefully for:

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The dobutamine may need to be decreased.
A client in the intensive care unit (ICU) is on a dobutamine drip.
During an assessment, the client states, "I was feeling better but
Dobutamine is a vasoactive adrenergic that works by increasing
now my chest is tight and I feel like my heart is skipping." Physical
myocardial contractility and stroke volume in order to increase
assessment reveals a heart rate of 110 beats per minute and
the cardiac output in heart failure clients. A serious side effect
blood pressure of 160/98 mm Hg. What is the nurse's immediate
of adrenergic drugs is the worsening of a preexisting cardiac
concern for this client?
disorder.
The nurse is caring for an older adult with mild dementia admitted
-Reorient frequently to time, place and situation.
with heart failure. What nursing care will be helpful for this client in
-Arrange for familiar pictures or special items at bedside.
reducing potential confusion related to hospitalization and change
-Spend time with the client, establishing a trusting relationship.
in routine? Select all that apply.
Today, with a gradual increase of daily activities

A basic principle of rehabilitation, including cardiac rehabilitation,

The nurse is developing a discharge plan for a client who has had is that rehabilitation begins on hospital admission and the client
a myocardial infarction and been in the cardiac care unit for 2 days. should increase activities as tolerated each day. It is not necessary
The client will be transferred to a telemetry unit tomorrow. When to wait until the client is moved to a telemetry unit as the client will
can the client begin cardiac rehabilitation? have EKG monitoring in both units. It is not necessary for the client
to have normal sinus rhythm to increase activity; monitoring will
detect potentially dangerous dysrhythmias. Delaying rehabilitation
activities is associated with poorer client outcomes.
Risk for infection.
The nurse is providing discharge teaching for a client with
Clients with endocarditis have a Risk for infection. The nurse
rheumatic endocarditis but no valvular dysfunction. On which
should stress to the client that they will need to continue antibiotics
nursing diagnosis should the nurse focus her teaching?
for a minimum of 5 years and that they will need to take prophy-
lactic antibiotics before invasive procedures for life.
a client 4 days postoperative after mitral valve replacement.

Having prosthetic cardiac valves places the client at high risk for
A nurse is caring for 4 clients on the cardiac unit. Which client has
infective endocarditis. Hypertrophic cardiomyopathy and repaired
the greatest risk for contracting infective endocarditis?
ventricular septal defects are moderate risks for infective endo-
carditis. Coronary stent placement isn't a risk factor for infective
endocarditis.
"I should rewrap the stump as often as needed."

The purpose of wrapping the residual limb is to shape the residual

limb to accept a prosthesis and bear weight. The compression
A client had a below-the-knee amputation secondary to arterial
bandaging should be worn at all times for many weeks after
occlusive disease. The nurse is instructing the client about resid-
surgery and should be reapplied as needed to keep it free of
ual limb care. Which statement by the client indicates that the
wrinkles and snug. The dressing should be changed daily to allow
client understands how to implement the plan of care?
for inspection of the stump incision. No lotions should be applied
to the stump unless specifically prescribed by the health care
provider (HCP) . The stump should not be elevated on pillows
because this will contribute to the formation of flexion contractures.
the client who had an aortic valve replacement 5 years ago.
Which client has a need for prophylactic antibiotic therapy prior to
Other implanted devices (hip, knee, ICD-implant cardio defib) can
dental manipulations?
increase the risk of infection, but the client with the greatest risk is
the one with the valve replacement.
monitoring strict intake and output.

Clients with impaired renal function scheduled for MDCT should

Which action is most important for the nurse to perform post be monitored closely after the procedure for urine output of at
procedure in a client with impaired renal function who is scheduled least 0.5 mmL/kg/hr because they are at risk for contrast-induced
for a multidetector-computed tomography (MDCT) to evaluate nephropathy. Before the procedure, there may be an indication for
peripheral circulation? IV fluids and sodium bicarbonate to alkalinize urine and protect
against free radical damage. Allergies should also be assessed
prior to the procedure and treated with steroids and/or histamine
blockers if necessary.
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decreased urinary output

The nurse is planning care for a client who has just returned to the Following surgical repair of an aortic aneurysm, there is a poten-
medical-surgical unit following repair of an aortic aneurysm. What tial for an alteration in renal perfusion, manifested by decreased
is a priority assessment for this client? urine output. The altered renal perfusion may be related to re-
nal artery embolism, prolonged hypotension, or prolonged aortic
cross-clamping during surgery.
A nurse is awaiting the arrival of a client from the emergency
dyspnea
department with a diagnosis of anterior wall myocardial infarction.
crackles
In caring for this client, the nurse would be alert for which signs
tachycardia
and symptoms of left-sided heart failure? Select all that apply.
-"Gradually increasing my exercise levels will help enhance circu-
lation through the heart."
A group has asked the nurse to discuss how lifestyle factors affect -"If I change my diet and lessen my intake of saturated fats and
heart health. Which statements by members of the group would trans fatty acids, this may decrease my cholesterol levels."
indicate that the teaching was effective? Select all that apply. -"As a borderline diabetic, if I lose weight and lessen my intake of
simple carbohydrates, this should benefit my heart."
-"Walking is excellent exercise to strengthen my heart."

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