Cardiovascular disorder examJesus PerezSeptember 7, 2023 Welcome to your Cardiovascular disorder examQuestion 262. CV disordersMr. Smith, a 57-year-old male, has been referred for an exercise stress test after reporting episodes of intermittent chest pain during physical activity. His primary care physician wants to evaluate the nature of his chest pain and potential coronary artery blockages. Mr. Smith is anxious about the procedure, stating he doesn't know what to expect.As a nurse preparing Mr. Smith for the exercise stress test, which of the following are essential requirements and preparations to ensure the test's safety and accuracy? Select all that apply: Instruct Mr. Smith to consume a meal an hour before the test to ensure he has sufficient energy. Ensure that emergency resuscitation equipment and medications are readily available during the test. Obtain a thorough medical history and list of medications to understand any contraindications or potential complications. Ask Mr. Smith to bring comfortable shoes and loose clothing suitable for exercise. Administer a sedative to Mr. Smith 30 minutes prior to the test to alleviate anxiety. Monitor Mr. Smith's vital signs and obtain a baseline ECG prior to beginning the test. Ensure that Mr. Smith had took his atenolol before the test Question 255. CV disordersSarah, a 37-year-old woman, comes to the clinic with complaints of pain, warmth, redness, and swelling in her left calf. She mentions having recently traveled on a long-haul flight. She also has a history of oral contraceptive use. Given her presentation and history, thrombophlebitis is suspected.Considering Sarah's presentation and potential diagnosis of thrombophlebitis, which combination of diagnosis, one parameter to monitor, and one nursing action would be most appropriate? Parameters to MonitorCalf circumference to assess for swelling.Temperature of the affected area.Pain intensity and quality.Presence of a palpable cord along the vein.Range of motion of the affected limb. Potential diagnosisDeep vein thrombosis (DVT).Superficial vein thrombosis.Cellulitis.Muscle strain.Baker cyst. Nursing actionElevate the affected leg to reduce swelling.Apply warm compresses to the affected area.Administer prescribed anticoagulants.Instruct the patient to avoid massaging the affected area.Educate the patient on the importance of ambulation and leg exercises.Question 244. CV disordersA 65-year-old male, Mr. Thompson, is admitted to the emergency department following a minor car accident. While his external injuries appear minimal, he reports increasing difficulty in breathing, along with a feeling of pressure in his chest. An echocardiogram has been ordered to rule out internal cardiac injury, specifically cardiac tamponade, given his complaints.Which of the following assessments would be indicative of cardiac tamponade in Mr. Thompson? Select all that apply Hypertension and bounding pulses. Decreased central venous pressure (CVP). Distended jugular veins when sitting at a 45-degree angle. A rapid, but weak, pulse. Pulsus paradoxus Muffled or distant heart sounds on auscultation. Increased urine output and light yellow urine. Absence of chest pain. Question 239. CV disordersMrs. Anderson, a 64-year-old woman, comes to the emergency department with a primary complaint of chest discomfort. She describes it as a squeezing sensation that began while she was gardening. The pain radiated to her left arm and was accompanied by shortness of breath and nausea. Mrs. Anderson reports that the discomfort lasted for about 20 minutes and then subsided. She also notes that she's had a few similar episodes in the past week that resolved with rest but is worried since today's episode was more prolonged.Based on Mrs. Anderson's presentation: Complete the diagram by selecting from the choices below to specify which potential condition the client is most likely experiencing, 2 actions to take, and 2 parameters the nurse would monitor to assess the client’s condition. PARAMETERS TO MONITORBUN and creatinineSerial ECG changesSerum potassiumBNP levelsExercise Stress Testing POTENTIAL CONDITIONPneumoniaGastroesophageal reflux (GERD)Acute myocardial infarctionUnstable angina CTIONS TO TAKEHave her drink a glass of cold water.Administer high-flow oxygen via non-rebreather mask.Instruct her to cough forcefully several times.Administer sublingual nitroglycerin, as prescribed.Rest or lie down the clientQuestion 265. CV disordersAna, a 29-year-old graphic designer, presents to the emergency department with a 10-day history of fever, fatigue, and shortness of breath. She recently returned from a camping trip and recalls being bitten by several ticks.A diagnosis of acute myocarditis is suspected. As the medical team starts treatment, the nursing staff plans for important actions considering both the diagnostic and therapeutic aspects of care, with special emphasis on infection control measures to prevent further complications.Which of the following are the most important nursing actions for a patient diagnosed with suspected acute myocarditis with a focus on infection control? Select all that apply Ensure strict hand hygiene before and after patient contact. Start the patient on broad-spectrum antibiotics without waiting for diagnostic confirmation. Educate the patient and visitors about the importance of wearing masks and hand sanitization. Obtain blood cultures before starting any antimicrobial therapy. Implement respiratory isolation until infectious causes are ruled out. Encourage patient mobilization to improve circulation and heart function. Regularly monitor vital signs, especially temperature, for any fluctuations. Vital SignsLab ResultsNurse's notesBP: 100/60 mmHgHR: 105 bpmRR: 22/minO2 Sat: 94% on room airWBC: 12,000 /µL (elevated)Hemoglobin: 11 g/dLHematocrit: 33%Serum potassium: 4.2 mEq/LBlood culture: PendingThe patient reports mild chest discomfort and has slight jugular vein distention. There is a small amount of drainage in the pericardial drain.Question 269. CV disordersMr. Evans, a 62-year-old male, underwent a pericardiocentesis 4 hours ago to relieve cardiac tamponade. He is now in the recovery unit and under continuous monitoring. His nurse is checking his latest lab results and monitoring for potential complications.What should the nurse prioritize monitoring in Mr. Evans, and which intervention is most appropriate? Monitor blood pressure for signs of hypotension. Auscultate lung sounds for signs of fluid overload. Monitor for signs of cardiac tamponade recurrence. Notify the healthcare provider of elevated white blood cell count. Monitor the pericardial drain for signs of infection. Increase the pericardial drain output to speed up fluid removal. Administer oxygen via nasal cannula to relieve chest discomfort. Question 250. CV disordersMark, a 64-year-old retired banker, was admitted to the cardiology department complaining of exertional chest pain that subsided at rest. An angiogram revealed a significant blockage in one of his coronary arteries. The cardiologist decided that a coronary angioplasty with stent placement femoral approach was the best course of action. The procedure was successfully performed without any complications. As Mark is transferred to the post-procedure unit, the nursing team prepares to provide post-angioplasty care.Which of the following are the most essential nursing actions in the immediate post-angioplasty care for Mark? Select all that apply Encourage Mark to ambulate and walk around the unit after the procedure. Assess Mark for back pain. Instruct Mark to avoid drinking fluids for the next 24 hours. Assess Mark's vital signs every 15 minutes for the first hour, then as per protocol. Allow Mark to sit in a chair to keep him comfortable. Check proximal pulses in the extremity used for the procedure. Encourage Mark to perform deep-breathing exercises every 10 minutes. Ensure Mark’s intake of fatty foods is increased to speed up recovery. Provide warm compresses to the insertion site to soothe any discomfort. Question 260. CV disordersMr. Anderson, a 62-year-old male, has been admitted to the cardiology ward for evaluation of recent episodes of dyspnea and palpitations. This morning, his cardiologist examined his recent ECG and decided to get a detailed view of the heart to rule out any structural abnormalities. Given the urgency of the procedure, you prioritize your nursing interventions.Which of the following actions will you take first to prepare Mr. Anderson for the TEE? Provide Mr. Anderson with education about the TEE procedure and what he can expect. Securely insert an IV catheter in Mr. Anderson's forearm for potential medication administration. Attach Mr. Anderson to a cardiac monitor to continuously assess his heart rhythm. Administer a sedative as prescribed to help him relax before the procedure. Take a brief history of any past allergic reactions, especially to local anesthetics. Ensure a signed consent form for the TEE is on file or obtain one. Instruct Mr. Anderson to abstain from eating or drinking, placing him on NPO status. Vital SignsNurse’s NotesBP: 135/75 mmHgHR: 78 bpmRR: 18/minO2 Sat: 97% on room airThe patient is resting comfortably but reports mild soreness at the catheter insertion site.Question 274. CV disordersMrs. Davis, a 60-year-old female, underwent a percutaneous coronary intervention (PCI) with stent placement yesterday following a myocardial infarction. She is now in the recovery unit and the nurse is monitoring her closely for potential complications.What should the nurse prioritize in her post-PCI assessment? Check for dysrhythmias by monitoring the cardiac monitor every hour. Encourage the patient to remain in bed for 12 hours Palpate the pulse distal to the insertion site every 15 minutes. Reassess the patient’s pain level every 4 hours. Monitor for signs of bleeding or hematoma formation at the catheter insertion site. Apply cold compresses to the catheter site Monitor the patient’s urine output every hour. Question 237. CV disordersJohn, a 45-year-old male, presents to the clinic for a routine checkup. Lately, he mentions having some shortness of breath when going up to the second floor of his house, and he finds it hard to be inside the freezer of his butcher shop without feeling chest pain."Based on coronary artery disease characteristics , and it is determined that in general and are risk factors in this CAD case.The nurse anticipates that John should receive and as a treatment for his condition."Question 249. CV disordersMaria, a 68-year-old woman with a history of type 2 diabetes and occasional chest discomfort, has been admitted to the hospital for a scheduled coronary arteriogram. She is visibly nervous and mentions she had some chest pain during a walk the previous day. On admission, her vitals are stable but her cardiac monitor shows a slower heart rate. As the nurse is preparing Maria for the procedure, she realizes there is crucial patient information that should be communicated to the health care provider (HCP) before proceeding.From the following pieces of information, which is the most important for the nurse to relay to the HCP before the coronary arteriogram? Maria's blood glucose level is 144 mg/dL (8 mmol/L). The cardiac monitor indicates sinus bradycardia with a rate of 56 beats/min. Maria recalls an episode of chest pain during her walk yesterday. Maria confirms she took her metformin 500 mg this morning. Maria's blood pressure is within the normal range. Maria reports mild anxiety about the procedure. Maria's last meal was 8 hours ago. Question 242. CV disordersThe nurse is performing the morning assessment on a patient who has breast cancer. The patient says her gown feels tight and uncomfortable at the neckline. She also reports feeling uneasy and having a restless night with mild shortness of breath and a dry cough.Complete the sentences by choosing the most probable option for the omitted information that corresponds with the same numbered list of options provided.The nurse suspects an oncology emergency and assesses the patient for additional signs and symptoms of . The priority nursing assessment is would be an ominous sign for this oncology emergency. The first nursing action is to Question 241. CV disordersMr. Ramirez, a 62-year-old male, has been admitted with a suspected myocardial infarction.Which of the following interventions is the priority for Mr. Ramirez? Educate Mr. Ramirez about the importance of lifestyle changes. Monitor for changes in the ECG, particularly arrhythmias. Encourage Mr. Ramirez to express his feelings and concerns. Discuss possible discharge plans with Mr. Ramirez. Start Mr. Ramirez on a high-protein diet. Encourage Mr. Ramirez to ambulate in the hallway. Check blood glucose levels every 4 hours. Administer anxiolytics as prescribed. Question 252. CV disordersMs. Martinez, a 58-year-old woman, is preparing for discharge after being admitted for acute exacerbation of heart failure. She lives alone and manages her own medications and daily activities. The nurse is reviewing Ms. Martinez's discharge plan to ensure she is well-prepared for self-care at home.Which topics will the nurse prioritize in discharge teaching for Ms. Martinez related to her heart failure? Select all that apply. How to monitor and record daily weight to detect fluid retention. Importance of notifying the healthcare provider if swelling or weight gain is noted. Importance of stopping exercise if heart rate increases significantly. Symptoms of worsening heart failure such as shortness of breath or increased fatigue. Purpose of chronic antibiotic therapy to prevent potential infections. How to read food labels to assess and limit sodium intake. Recommended restrictions on fluid intake. Date, time, and importance of follow-up appointments to monitor disease progression. Nurse's notesVital SignsThe patient has a pericardial drain in place, and there is minimal drainage. The insertion site is covered with a sterile dressing.BP: 115/70 mmHgHR: 88 bpmRR: 16/minTemp: 100.1°F (37.8°C)Question 267. CV disordersMs. Garcia, a 45-year-old female, is admitted to the cardiac unit after a pericardiocentesis due to cardiac tamponade. She has a history of systemic lupus erythematosus (SLE) and was recently treated for pericarditis. The nurse is preparing to care for Ms. Garcia and administer her medications.Which of the following actions should the nurse take to apply the principles of infection prevention during Ms. Garcia's care? Wear clean gloves while changing the sterile dressing on the pericardial drain. Use sterile technique when changing the pericardial drain dressing. Teach the patient to clean the pericardial drain site daily with soap and water. Wear a mask while caring for the pericardial drain. Change the pericardial drain dressing every 12 hours. Perform hand hygiene before and after changing the dressing. Limit the number of healthcare workers entering the room to prevent infection. Question 256. CV disordersDavid, a 59-year-old lawyer, presents to the emergency department with complaints of chest pain that started about 3 hours ago. The pain is described as a tight, squeezing sensation radiating to his left arm. With a suspicion of an acute coronary event, the healthcare provider orders laboratory tests, including cardiac troponin T and cardiac troponin I as workup.Which of the following statements about cardiac troponin T and cardiac troponin I are correct? Select all that apply Cardiac troponin T and I are specific markers for skeletal muscle damage. Decreased levels of cardiac troponin T and I can be indicative of myocardial injury. Cardiac troponin levels begin to rise within 3-4 hours after the onset of myocardial injury. Cardiac troponin levels are only elevated in patients with cardiac diseases. Cardiac troponin T and I are the preferred biomarkers for the diagnosis of myocardial infarction Cardiac troponin levels peak within an hour of myocardial injury and decline rapidly. Decreased cardiac troponin levels are always indicative of a new cardiac event and never due to chronic conditions. Question 245. CV disordersMr. Henderson, a 72-year-old gentleman, has been under observation for a potential cardiac issue. He's been diagnosed with aortic stenosis. During a routine examination by the nurse in the cardiac ward, several findings are documented.Which of the following findings in Mr. Henderson, who has aortic stenosis, will be most crucial for the nurse to report to the health care provider? Complaints of dizziness when standing up from a seated position. Temperature of 102.1°F (38.9°C) which is notably higher than his baseline. Presence of a loud systolic murmur noted over the sternum. Blood pressure reading of 110/88 mm Hg. Weak radial and pedal pulses palpated during a vascular assessment. A complaint of chest discomfort when lying flat. Shortness of breath after mild physical activity. Occasional nocturnal cough. Question 251. CV disordersA 67-year-old retired school teacher, Anna visits her primary care physician for a routine check-up. She mentions occasional pain in her calves while walking that relieves upon resting. Suspecting peripheral arterial disease (PAD), the physician orders an Ankle-Brachial Index (ABI) test. The nurse prepares to perform the ABI to determine the severity of PAD.Which of the following three actions is correct when performing the ABI on Anna? Instruct Anna to lie down in a supine position for the test. Measure the blood pressure in Anna's thighs instead of her arms. Use a Doppler ultrasound device to detect arterial flow in the brachial and dorsalis pedis arteries. Determine the ABI by dividing the ankle systolic pressure by the thigh systolic pressure. Ensure Anna has not consumed caffeine or smoked at least 30 minutes before the test. Calculate the ABI by subtracting the higher ankle pressure from the brachial pressure. Record the highest systolic pressure obtained at the ankles and the brachial artery. Advise Anna to wear tight-fitting socks for accurate measurements. Vital SignsNurse's notesBP: 135/85 mmHgHR: 90 bpmRR: 24/minO2 Sat: 96% on room airThe patient reports feeling overwhelmed and has difficulty resting due to her discomfort. She expresses concern about her baby’s well-being.Question 268. CV disordersMrs. Lee, a 52-year-old woman, is 34 weeks pregnant and has a history of cardiovascular disease. She is admitted to the obstetric unit for management of shortness of breath and fatigue. She is receiving medication to control her heart rate, but her symptoms persist. Mrs. Lee is uncomfortable and anxious.Which non-pharmacological comfort measures should the nurse provide to Mrs. Lee? Encourage deep breathing exercises. Elevate the head of the bed to 90 degrees. Offer a warm blanket and dim the lights. Teach the patient to hold her breath during periods of discomfort. Reassure the patient about the baby’s well-being. Encourage frequent ambulation to improve circulation. Apply a heating pad to the chest area. Question 236. CV disordersMrs. Evans, a 58-year-old woman, presents to the emergency department with complaints of sharp, stabbing chest pain with referral to the trapezius ridge, neck, which is worse during inspiration., with the diagnosis of acute pericarditis.Based on Mrs. Evans's presentation and the findings, select the three most appropriate responses related to the auscultatory finding. A friction rub is typically heard in conditions like pulmonary embolism. The primary cause of a friction rub in this patient is likely related to her recent viral infection. The sound is produced by the movement of inflamed layers against each other. Auscultating for this sound is best done using the diaphragm of the stethoscope. Friction rubs are most commonly associated with myocardial infarctions. Encouraging the patient to lay flat without any head elevation will likely alleviate the chest pain. One of the nursing actions for this patient include placing the patient in leaning forward Question 253. CV disordersMr. Richards, a 72-year-old man with a history of coronary artery disease, was admitted to the hospital due to worsening chest pain. As part of the resuscitation team, the nurse is closely following the protocol and directions from the health care provider in charge. Upon the provider's request, the nurse administers epinephrine 1 mg IV to Mr. Richards to help stimulate his heart.Following the administration of the medication, which of the following actions should the nurse prioritize next? Get the defibrillator ready for possible immediate use. Step forward and assume the role of performing chest compressions. Clearly announce to the team, “Epinephrine 1 mg IV has been administered.” Keep a vigilant check on Mr. Richards' level of consciousness and responsiveness. Recheck the IV line for patency. Assess the pulse and rhythm through the cardiac monitor. Begin preparing for a possible second dose of medication if ordered. Question 248. CV disordersSophie, a 62-year-old woman, presents to the cardiology clinic with complaints of progressive shortness of breath and overwhelming fatigue over the past month. She's concerned because these symptoms have limited her daily activities and disrupted her sleep. She shares that she has had to prop up more pillows to breathe comfortably at night and has noted swelling in her ankles by the evening. On examination, there is slight bilateral ankle edema, and upon auscultation, there are crackles in the lower lung lobes. The cardiologist is suspecting heart failure and orders a series of lab tests to assist in the diagnosis.From the following lab tests, which will be the most useful to monitor in relation to a potential diagnosis of heart failure? Serum potassium B-type natriuretic peptide (BNP) Blood urea nitrogen (BUN) Hematocrit Serum creatinine Total cholesterol Alanine aminotransferase (ALT) Troponin I Question 273. CV disordersMr. Smith, a 68-year-old male, was recently diagnosed with atrial fibrillation. He has been experiencing palpitations and intermittent dizziness but does not want to rely on medications to manage his condition. The nurse is discussing non-pharmacological interventions with him.Which non-pharmacological interventions should the nurse recommend to Mr. Smith to help manage his atrial fibrillation? Encourage regular aerobic exercise, such as running Teach Mr. Smith to practice deep breathing and relaxation techniques Recommend weight reduction if overweight Advise Mr. Smith to avoid caffeine and stimulants Suggest that Mr. Smith engage in vigorous physical activities Encourage the consumption of a high-sodium diet Recommend short naps during the day Question 240. CV disordersDuring a community health fair, you're asked to demonstrate cardiopulmonary resuscitation (CPR) steps on a manikin.Which of the following is the correct sequence for performing CPR on an adult? Check for responsiveness, begin compressions, give two breaths, call 911 Check for responsiveness, call 911, begin compressions, give two breaths Call 911, check for responsiveness, give two breaths, begin compressions Check for responsiveness, give two breaths, call 911, begin compressions Call 911, begin compressions, check for responsiveness, give two breaths Begin compressions, call 911, check for responsiveness, give two breaths Check for responsiveness, call 911, give two breaths, begin compressions Call 911, give two breaths, begin compressions, check for responsiveness Begin compressions, check for responsiveness, give two breaths, call 911 Question 272. CV disordersMs. Parker, a 70-year-old female, has a long-standing history of heart failure and has been admitted to the hospital due to increased shortness of breath and peripheral edema. She is now stabilized and the nurse is providing discharge education.What should the nurse emphasize in Ms. Parker’s discharge education regarding self-care at home? Restrict fluid intake to 2 liters daily. Monitor weight every week and report an increase of more than 5 pounds. Follow a low-sodium diet and read food labels Avoid any physical activity that increases heart rate. Consume small frequent meals rich in potassium. Record weight daily and notify the provider of a gain of 2-3 pounds in 24 hours. Elevate legs when resting 1 out of 25 You cannot switch tabs while taking this quiz!You are not allowed to switch tabs violation has been recorded.You cannot minimize full screen mode!You are in NCLEX simulator mode and not allowed to minimize full screen while taking this quiz, violation has been recorded.