Heart the NCLEX

A pt admitted to the hospital with chest pain and history of type 2 diabetes mellitus is scheduled for cardiac catheterization. Which medication would need to be held for 24 hours before the procedure and for 48 hours after the procedure?

• Regular insulin

• Glipizide (Glucotrol)

• Repaglinide (Prandin)

• Metformin (Glucophage)

Answer explanation

Glucophage should be withheld 24 hours before and 48 hours after cardiac catheterization. Contrast medium is used during a cardiac catherization and can affect kidney function, leaving the patient at an increased risk for lactic acidosis.

A MedSurg nurse is reviewing the laboratory test results for a pt who has been transferred from the ICU. The nurse notes that a cardiac troponin T level assay was performed while the client was in the ICU. The nurse determines that this test was performed to assist in diagnosing which condition?

• Heart failure

• Myocardial infarction

• Atrial fibrillation

• Ventricular tachycardia

Answer explanation

Troponin is a myocardial intracellular protein that becomes available to the bloodstream

after myocardial cell death because of ischemia. Blood levels therefore rise. Normally, no troponins can be detected in the blood.

Which laboratory test results may be associated with peaked or tall, tented T waves on a client's electrocardiogram (ECG)?

• Chloride level of 98 mEq/L

• Sodium level of 135 mEq/L

• Magnesium level of 1.6 mEq/L

• Potassium level of 6.8 mEq/L

Answer explanation

The nurse is caring for a client who has been hospitalized with a diagnosis of angina pectoris. The client is receiving oxygen via nasal cannula at 2 L/min. The client asks why the oxygen is necessary. The nurse should provide which information to the client?

• Oxygen has a calming effect

• Oxygen will prevent the development of any thrombus

• Oxygen dilates the blood vessels so that they can supply more nutrients to the heart muscle

• The pain of angina pectoris occurs because of a decreased oxygen supply to heart cells

A client with a first-degree heart block has an electrocardiogram (ECG) taken during an episode of chest pain. The nurse knows that which ECG finding would be an indication of first-degree heart block?

• Prolonged PR interval

• Tall, peaked T waves

• Widened QRS complex

• Presence of Q waves

Answer explanation

First-degree atrioventricular (AV) block is a condition of abnormally slow conduction through the AV node. It is defined by ECG changes that include a PR interval of greater than 0.20 without disruption of atrial to ventricular conduction. This condition is generally asymptomatic and discovered only on routine ECG

The nurse working in a long-term care facility is assessing a client who is experiencing chest pain. The nurse should interpret that the pain is most likely caused by myocardial infarction (MI) on the basis of what assessment finding?

• The client is not experiencing dyspnea

• The client is not experiencing nausea or vomiting

• The pain has not been relieved by rest and nitroglycerin tablets

• The client says the pain began while she was trying to open a stuck dresser drawer

Answer explanation

The pain of MI is not relieved by rest and nitroglycerin and requires opioid analgesics, such as morphine sulfate, for relief. It typically begins spontaneously, lasts longer than 30 minutes, and frequently is accompanied by associated symptoms (suchas nausea, vomiting, dyspnea, diaphoresis, or anxiety). Angina is often is precipitated by exertion or stress, is accompanied by few associated symptoms, and is relieved by rest and nitroglycerin.

A client with iron deficiency anemia complains of feeling fatigued almost all of the time. The nurse should respond with which statement?

• "The work of breathing is increased when the client is anemic."

• "Blood flows more slowly when the hemoglobin or hematocrit is low."

• "The body has to work harder to fight infection in the presence of anemia."

• "Adequate amounts of hemoglobin are needed to carry oxygen for tissue metabolism."

Which location is the correct position for the V1 lead when performing a 12-lead

electrocardiogram?

• Fourth intercostal space left sternal border

• Fourth intercostal space right sternal border

• Fifth intercostal space left midaxillary line

• Fifth intercostal space left midclavicular line

Answer explanation

The nurse is monitoring the cardiac telemetry of a patient with heart failure who is receiving IV furosemide (Lasix). The nurse notes that the patient's cardiac rhythm has changed to this pattern. The nurse know this is likely due to which problem?

• An impending myocardial infarction (MI)

• Dehydration

• Hypokalemia

• Pacemaker dysfunction

Answer explanation

Lasix is a potassium wasting loop diuretic which can cause hypokalemia. Hypokalemia results in slowed conduction, delayed ventricular repolarization, shortened refractory period and increased automaticity. ECG changes include flattening and inversion of T waves in mild hypokalemia, followed by Q-T interval prolongation, visible U wave and mild ST depression in more severe hypokalemia

Prior to administering digoxin (Lanoxin) to a 56 y/o pt, the nurse notes the pt's HR is 52 BPM. The nurse makes which interpretation about this information?

• The nurse should administer this medication as the pt is receiving digoxin to increase HR

• Assessment of pt HR is not relevant in the administration of digoxin

• This HR is normal as a result of the effects of digoxin

• The nurse should hold this medication and contact the provider

Answer explanation

Digoxin:

HF: Increases contractility.

Supraventricular Arrhythmias: Increases effective refractory period/decreases conduction velocity, decreases heart rate.