Cardiac

A nurse is caring for a client who has heart failure and a prescription for digoxin. Which of the following statements by the client indicates an adverse effect of the medication?

• "I can walk a mile a day."

• "I've had a backache for several days."

• "I am urinating more frequently."

• "I feel nauseated and have no appetite."

Answer explanation

Anorexia, nausea, vomiting, and abdominal discomfort are early signs of digoxin toxicity.

A nurse is caring for a client who has pericarditis and reports feeling a new onset of palpitations and shortness of breath. Which of the following assessments should indicate to the nurse that the client may have developed atrial fibrillation?

• Different blood pressures in the upper limbs.

• Different apical and radial pulses.

• Differences between oral and axillary temperatures.

• Differences in upper and lower lung sounds.

Answer explanation

Atrial fibrillation is rapid, disorganized electrical activity of the heart in which the atrium depolarizes too quickly and sends erratic impulses to the ventricles. The presence of a pulse deficit between the apical and radial pulses is an indication of atrial fibrillation. The nurse should assess further by obtaining an ECG or telemetry reading.

A nurse is completing a medical interview with a client who has elevated cholesterol levels and takes warfarin. The nurse should recognize that which of the following actions by the client can potentiate the effects of warfarin?

• The client follows a low-fat diet to reduce cholesterol.

• The client drinks a glass of grapefruit juice every day.

• The client sprinkles flax seeds on food 1 hr before taking the anticoagulant.

• The client uses garlic to lower cholesterol levels.

Answer explanation

The nurse should recognize that garlic can potentiate the action of the warfarin.

A nurse is assessing a client who has left-sided heart failure. Which of the following findings should the nurse expect?

• Jugular venous distention

• Abdominal distension

• Dependent edema

• Hacking cough

Answer explanation

Right-sided heart failure raises the pressure and volume within the jugular veins, making them visibly distended when the client is sitting or the head of the bed is elevated more than 30°.

Abdominal distension is a manifestation of right-sided heart failure that occurs due to venous congestion.

Dependent edema is a manifestation of right-sided heart failure. Pressing edematous skin with a finger leaves a transient indentation (pitting).

A hacking cough is a manifestation of left-sided heart failure that occurs due to pulmonary congestion.

A nurse is caring for a client who reports heart palpitations. An ECG confirms the client is experiencing ventricular tachycardia (VT). The nurse should anticipate the need for taking which of the following actions?

• Defibrillation

• Elective cardioversion

• CPR

• Radiofrequency catheter ablation

Answer explanation

Elective cardioversion is the priority intervention when the client is awake and responsive. Ventricular tachycardia might not be an immediate threat to the client, but it does require intervention to prevent long-term cardiac impairment.

A nurse is caring for a client who develops a ventricular fibrillation rhythm. The client is unresponsive, pulseless, and apneic. Which of the following actions is the nurse's priority?

• Defibrillation

• Airway management

• Epinephrine administration

• Amiodarone administration

Answer explanation

The greatest risk to the client is death from a lack of cardiac output. Ventricular fibrillation is a lethal rhythm in which the ventricles are in a quivering pattern and there is no atrial activity. Defibrillation is essential to resolve ventricular fibrillation promptly and convert the rhythm to restore cardiac output. The nurse should follow defibrillation with cardiopulmonary resuscitation and repeated defibrillation, if necessary, to convert the ventricular fibrillation into a sustainable rhythm.

A nurse is teaching a client who has a new diagnosis of atrial fibrillation. The nurse should instruct the client to monitor for which of the following complications?

• Bradycardia

• Pulmonary embolism

• Peripheral vascular disease

• Hypertension

Answer explanation

Altered atrial contractions can cause blood pooling and thrombus formation. The client is at risk for developing a pulmonary embolism or embolic stroke. The client should monitor and report immediately manifestations, such as shortness of breath, or neurological changes.

A nurse is assessing a client who has mitral valve stenosis. Which of the following findings should the nurse expect?

• A heart murmur

• Bradycardia

• Clubbing of the fingers

• Barrel chest

Answer explanation

A murmur is a swishing or blowing sound heard when auscultating the heart. It is caused by a backward flow of blood due to an incompetent valve.

A nurse in an urgent care center is assessing a client who reports a sudden onset of irregular palpitations, fatigue, and dizziness. The nurse finds a rapid and irregular heart rate with a significant pulse deficit. Which of the following dysrhythmias should the nurse expect to find on the ECG?

• First-degree AV block

• Atrial fibrillation

• Sinus bradycardia

• Sinus tachycardia

Answer explanation

First-degree AV block is a regular rhythm with a prolonged P-R interval. A pulse deficit does not occur.

Atrial fibrillation causes a disorganized twitching of the atrial muscles. The rate is irregular with no visible P waves. The ventricular response is irregular which results in an irregular pulse and a pulse deficit.

Sinus bradycardia is a slow heart rate with a regular rhythm. Therefore, a pulse deficit does not occur.

Sinus tachycardia is a rapid heart rate with a regular rhythm. Therefore, a pulse deficit does not occur.

A nurse is reviewing the medical record of a client who has hypertension and a new prescription for metoprolol. Which of the following findings should the nurse investigate further?

• Diet-controlled Type 2 diabetes mellitus

• A history of left-sided heart failure

• A concurrent prescription for Viagra

• Recently treated bilateral pneumonia

Answer explanation

The nurse should further investigate the client’s history of heart failure. Although metoprolol can be used to treat heart failure, it can also cause heart failure, so this medication should be used with great caution with a client who has a history of heart failure. The nurse should teach the client to watch for signs of increasing left-sided heart failure, such as shortness of breath and weight gain indicating fluid retention, and report these findings to the provider.